When a high-profile politician makes tackling the country's most dangerous health threat a top item on his agenda, public health people like me usually feel a certain contentment -- that something is right in the world.
But when New York Mayor Michael Bloomberg announced last week that his administration was planning to ban sugary beverages larger than 16 ounces, that catharsis I expected to feel wasn't quite there -- something was amiss.
Don't get me wrong: obesity is the most dangerous epidemic our country has faced since the 1918 flu pandemic.
Yes, epidemic -- don't be fooled by its creeping pace or how seemingly "normal" obesity has become: in fact, these are precisely the reasons why we should be afraid.
Check out these numbers: Projections published in the journal Obesity suggest that by 2030, over half of American adults will be obese -- and nearly 90% will be overweight. What's worse, public health experts have forecasted that increases in obesity will lead to the first decline in life expectancy in the US in over 100 years.
Beyond the direct human toll, the obesity epidemic also has the potential to bankrupt our social services by sending Medicare costs through the roof and further taxing our already crumbling infrastructure. Researchers have even warned that obesity will contribute to climate change as obese people consume more greenhouse gas-emitting products -- like red meat and car travel.
So the ongoing effort to tackle the obesity epidemic in NYC is laudable, even heroic. And I applaud Mayor Bloomberg on his leadership.
But this particular approach -- banning large-sized sugary drinks -- is both misguided and gimmicky.
There's no question that sugary beverages contribute to obesity -- a review of all of the studies that have considered the relationship between drinking sugary beverages and obesity found conclusive evidence of this fact.
But the question is how?
When you think about the relationship between soda and obesity, the image of some super-obese guy drinking a Big Gulp may pop into your mind. It's the natural assumption -- that, of course, that huge 28-ounce is probably to blame for that guy's mammoth weight. And for that guy, it probably is. The problem, though, is that that guy isn't an accurate picture of what's happening to the whole population.
The average American consumes about 175 calories per day in sugary beverages -- that's less than what's in a 16-ounce can of Coke. And studies have demonstrated that the risk of obesity increases upon consuming only small amounts of sugary beverage. This is especially true in children. For example, one study in the Lancet among middle schoolers showed that the chances of obesity increased by 60% with each additional 12-ounce serving consumed per day. What this suggests is that getting all middle schoolers to drink 12 ounces less of soda each day would prevent obesity in a sizable proportion of them.
But while the proposed ban would stop kids in New York from drinking a 16-ouncer, it does nothing to persuade them to drink any less on a daily basis, nor does it make it much more difficult for them to keep drinking.
Ultimately, the real issue with sugary beverages isn't that some people drink large amounts, it's that many people drink relatively small amounts. And banning large-sized drinks does little to address that issue. A per-ounce soda tax, or place-based approaches -- such as banning the sale of certain sugary beverages in schools -- might be better-equipped.
But this proposal has stoked a dangerous fire. With its over-simplicity and somewhat draconian character, it makes a show of anti-obesity policy. While that may put a feather in Mr. Bloomberg's cap in some circles, it makes for easy fodder in others. This ban gives conservative pundits and politicians who would stifle any pro-public health regulation, effective or otherwise, just the material they need to wax philosophical about the "nanny state" and to bemoan the "intrusion of government in our lives."
By marshaling anti-government advocates in this way, the proposed ban may do more harm than good in the long-term. Already, critics have lambasted the mayor over this approach with indictments of paternalism and elitism striking sensitive cords with Americans already weary of government interventions. So rather than champion the cause of anti-obesity policy, as he intended, Mr. Bloomberg has turned the obesity issue -- one that should be uniting rather than divisive -- into a political hot-potato that few elected leaders will want to handle in the future.
In the end, obesity is, and looks to remain, one of the most serious public health crises of our time. While policy actions are needed, these actions need first to be in line with public health science, as well as driven more by the imperative of the issue at hand rather than political gamesmanship.
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