When New York City's Mayor Michael R. Bloomberg announced last week that he planned to propose a municipal ban on large sodas in restaurants, he triggered strong reactions that ranged from congratulatory to incredulous. On the one hand, sugar-sweetened beverages are an undeniable contributor to growing rates of obesity, diabetes and other forms of metabolic syndrome in both children and adults. On the other, some argue, at a certain point point, individuals must take responsibility for their own dietary choices.
But beyond that, would a ban on big gulps actually work to reduce obesity-related illness? We asked two leading experts to weigh in.
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Oversized beverages, including 7-Eleven's Big Gulp and just about all medium and large size beverages sold at fast-food establishments, may no longer be available to consumers in New York City if Mayor Bloomberg's ambitious proposal to limit the portion sizes of sweetened beverages is passed by the city's board of health in June. In fact, the "small" soda at McDonald's may soon become the largest option available. And even Burger King's 22-ounce "small" would be banned. According to the mayor, it is time for food eateries to start shaving down their portions.
The proposed ban would restrict the sale of sodas and other sugary drinks that are larger than 16 fluid ounces in food establishments such as restaurants, movie theaters, sports arenas, delis, and street carts. It would include the popular 20-ounce soda bottle from the corner deli and, of course, oversized fountain drinks available in fast-food establishments and movie theaters. The ban would not affect diet drinks, fruit juice, dairy-based drinks such as milkshakes, or alcoholic beverages. Nor would it affect beverages sold in grocery stores.
It is no surprise that the beverage industry is up in arms about the proposal, and feels that the city's department of health is unfairly singling out soda. Indeed, the ban would affect the sales of their product. According to the New York Times, the New York City Beverage Association criticized the city's proposal:
"The New York City health department's unhealthy obsession with attacking soft drinks is again pushing them over the top," the industry spokesman, Stefan Friedman, said. "It's time for serious health professionals to move on and seek solutions that are going to actually curb obesity."
According to the New York City Department of Health, sugary, sweetened beverages are a major contributor to the current obesity epidemic both in New York City and in the rest of the country. In a phone interview, Dr. Thomas Farley, New York City's health commissioner, indicated that the extra calories from sweetened beverages have indeed contributed substantially to rising obesity rates throughout our country.
This is not the first time the New York City Department of Health has tried to help us trim our portions. In January, they launched a portion-size education campaign -- "Cut Your Portions. Cut Your Risk" -- featuring ads on subways encouraging New Yorkers to trim their portions to reduce their risk of health problems. As I previously wrote, the city's health department has been very proactive in fighting obesity and other public health issues.
So, what should we make of this new proposal to ban oversized sugary drinks?
This campaign makes sense at a time when food portions have increased and so have rates of obesity.
As a researcher tracking portion size trends, food portions have increased steadily over the years, and so have we. We have grown accustomed to oversized portions, and we have come to expect them. My research found that portion sizes are now two to five times larger than they were in the 1950s. When McDonald's opened, for example, the only size soda available was 7 ounces. When Burger King first opened, the company offered a 12-ounce small and a 16-ounce large. Boy have we grown! Burger King's small is now 22 ounces and its large is 42 ounces. I think it is time to return to those more reasonable sizes.
Large portions may contribute to obesity in several ways. Large portions contain more calories than small portions. For example, an 8-ounce soda contains 100 calories, while a 64-ounce Double Gulp without too much ice contains nearly 800 calories. Large portions also encourage us to consume more and to underestimate how much we are really eating. Sugar-sweetened beverages, in particular, provide no nutritional value whatsoever. As a registered dietitian counseling clients on healthy eating, I advise eating a small portion of foods low in nutritional value.
If food companies do not sell large sizes, consumers will not buy them. Of course, you can get around the ban by purchasing several drinks. Indeed, four 16-ounce sodas would amount to just one 64-ounce Double Gulp, but it's going to cost a lot more money. And will consumers want to pay for them?
Part of the portion problem is that the current price structure encourages us to buy bigger sizes. All too often, the bigger the portions, the less we pay per ounce. At a local 7-Eleven, the cost of the smallest size available (20 ounces) is roughly five cents per ounce, but the largest size (64 ounces) goes down to just two cents per ounce. It is hard to resist such a bargain.
As an educator and clinician, I would absolutely continue to advocate for better education and public health campaigns. I would urge such campaigns to begin at home and continue in the schools for our children to receive training on nutrition and health -- in particular, on the relationship between calories and portion sizes. But education has not proven to be the answer thus far. Research looking into the effectiveness of the posting calories on menu boards has not been very promising. The health department found that 15 percent of patrons improved their choices by looking at calorie counts on menu boards. Indeed, we need to take this a step further. And Mayor Bloomberg is taking action.
Given the health consequences and enormous cost of our country's obesity epidemic, it is time to return eating less. And banning the large sizes of unhealthy sugar-sweetened beverages is a good place to begin. The city has unveiled other such public health campaigns, and it appears that they may actually be working. Smoking has declined and so have rates of childhood obesity in New York City. I applaud the health department for its efforts in fighting to improve the public health of New Yorkers and hope other health departments around the country follow New York's lead.
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Last week, New York City mayor Michael Bloomberg unveiled his proposal to ban the sale of sweetened sodas in sizes larger than 16 ounces. While this proposal might intuitively seem like a stride in the right direction -- who the heck needs more than 16 ounces of soda at a time anyway!? -- I personally couldn't disagree more with the move. For one, the implementation is flawed, with 2-liter-peddling supermarkets and sugar-laden juices escaping the executioner's axe, and I also believe it will be a challenge to stem the actions of a motivated Big Gulp purchaser (two 16-ouncers should do the trick, right?).
But more fundamentally, I disagree with the move on a philosophical basis. We live in the age of corporate social responsibility, whereby we expect corporations to self-regulate themselves in the interest of the environment, consumers, and the world community. We in fact become outraged when we hear of a corporation that has violated what we believe to be its socially responsible actions; Wall Street, Apple, Nike and BP, to name just a few, have all drawn ire by violating this responsibility. It's easy to vilify corporations that, in their insatiable appetite for profits, have thrown their implicit social contracts out the window. But what about the individual, whose appetite, too, leads him to violate social trust?
I believe America is in a crisis now, not only of corporate or governmental social responsibility, but of personal social responsibility; we're uncertain of whether Wall Street or Uncle Sam has our best interest at heart, but just the same we should be looking at our neighbor. Our problem is not simply a matter of sugar, fat and salt; it is a matter of choice, behavior and education. We live in a country where we make sure our children are mathematically educated enough to figure out that two 16-ounce sodas will get them their Big Gulp fix, but where roughly 96 percent of them are not required to have daily physical education classes in school. What exactly are we teaching them about behavior and choice?
Set aside what we're teaching young America, let's look at ourselves in the mirror. Most of us know what's healthy and what's not. I have had the privilege of meeting folks all over the country, and getting insight into their daily routines:
John Doe: "What can I do to eat better? I feel like I eat okay but I'm already heavy and continue to gain weight."
Me: "Well, let's start with breakfast -- what did you eat?"
John Doe: "I know what you're going to say. I probably shouldn't have had the sausage, egg and cheese on a bagel."
Me: "Bingo. So what could you eat instead?"
John Doe: "I guess I should have oatmeal, and maybe some fruit."
Me: "Well there's a big step in the right direction!"
I cannot tell you how many conversations like this I've had over the years about food and exercise. We know what we're doing to ourselves, and most of us know how to change it. And in situations where additional warnings and information may be warranted, sure, I'm all for it; let's slap a warning label on soda, maybe even a picture of a diabetic amputee's leg -- whatever it takes. Education is key.
However, our crisis isn't simply one of education. As I said above, it's one of personal social responsibility. Type 2 diabetes, in which insidious sugar sources like soda play a big role, costs this country in excess of $174 billion each year. Most Type 2 diabetics know that their lifestyles are unhealthy but do not take adequate action to prevent or reverse the disease. And who pays for it? How would we react to a corporation that did the very same? (Note: This is NOT an attack on diabetics; I am merely illustrating a point.)
And my point is simply this: Drinking soda, or better stated, our right to drink soda, is actually good for us. Isn't that what makes America great? We're the land of free choice. However, when government takes an arbitrary legislative potshot at the symptom, not the cause, of a problem, how much better off are we? Do we want to be hobbled by government making lifestyle choices for us, or empowered by government teaching and supporting better choices? I for one would much rather see legislation making daily physical education and nutrition classes mandatory for our students, ingraining better lifestyles and choices. And I'd love to see the Big Gulp yanked -- not due to legislation, but due rather to poor sales from a healthy, educated consumer.
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