Last Wednesday, New York City Mayor Michael Bloomberg unveiled his administration's latest salvo in its war against obesity. This time, it's a soda regulation to prohibit movie theaters, food trucks and fast food chains from serving sugary drinks in cups that hold more than 16 ounces. To its critics, the policy is one more instance of the nanny state restricting consumers' choices. But when citizens become a victim of their choices because they are surrounded by hazardous options, the case for an unrestricted market weakens. Until more policymakers implement boundary-pushing policy experiments such as Mr. Bloomberg's, the U.S. will continue its gradual plod to the social and fiscal epidemic known as obesity.
According to the U.S. Center for Disease Control (CDC), obesity rates have stampeded upward over the past two decades. Depressingly, the CDC estimates that more than one-third of U.S. adults and 17% of children are currently obese. As obesity has risen, government efforts to turn the tide have been few, limited and largely unsuccessful. Meanwhile, a growing amount of research continues to link obesity to shorter life expectancies, greater employee absenteeism, dramatically higher healthcare costs and various forms of discrimination.
Parallels to the anti-obesity movement can be drawn from the anti-smoking movement. Much like smoking, individual cases of obesity are often written off as failures of personal responsibility or as untouchable products of free will. If only we educate and persuade consumers, so the anti-smoking campaign logic went, then they'll make the right choices. But public service announcements like those run by Partnership for a Drug-Free America couldn't cut smoking rates on their own. It took enforcement actions that restricted minors' access to cigarettes, prevented advertising to children, limited where cigarettes could be smoked, and taxed cigarette purchases to make the intake of carcinogens more expensive. In the end, it took public policy, not just public service announcements, to reduce U.S. smoking rates.
Unlike anti-smoking advocacy, anti-obesity policymaking is a much less mature field, and the public is still unsure when -- or if -- it wants the government meddling in what it eats and drinks. Despite the significant responsibility for obesity possessed by the food industry for how food is produced, marketed and distributed, blame for obesity is still directed heavily at obese individuals. Dietary or exercise failings aside, heaping social disapproval upon the obese is morally unacceptable and dangerously exacerbates the U.S.'s existing fetish for unhealthy body imagery.
Accordingly, one of the greatest lingering barriers to solving obesity is the tremendously personal nature of regulating what foods and beverages individuals can put into their bodies. Should government really tell us what kind of soda we can buy? However, under Mr. Bloomberg's policy, consumers determined to ingest more than 16 ounces of a sugary beverage can still do so under free refill policies or through the purchase of multiple servings. Moreover, grocery stores and convenience stores will still be free to sell sweetened beverages in existing sizes.
Rather, Mr. Bloomberg's policy is an example of what University of Chicago professors Cass Sunstein and Richard Thaler have coined "nudging" -- designing public policies to create a choice architecture that encourages rather than forces the public to make better decisions. Under their view, an unrestricted market does not always lead individuals to make rational choices due to their inherent psychological biases and irrational tendencies. Policymakers who solve such mental riddles can provide a valuable weapon for public good -- the ability to help consumers improve their lives simply by becoming better personal decision-makers.
In the same vein, the proposed New York policy does not stop individuals from drinking 32 ounces of a sugary beverage. Instead, it forces them to buy it in two installments. It's a nuanced change, but it significantly alters how consumers are presented with their choice set. Instead of the retailer nudging customers into purchasing more calories by steeply discounting plus-sized beverages, New York will be doing the opposite: nudging consumers to drink less of high calorie beverages by asking, in effect, "Do you really need those extra 16 ounces of Coca-Cola?" and "What about drinking Diet Coke or a Vitamin Water instead?" Any marketing professional knows that customers are much more likely to do pretty much anything if the default choice is "yes" instead of "no." In much the same manner, Mr. Bloomberg is attempting to require the consumer to make a conscious opt-in decision to spring for a second serving, get a free refill, or downgrade to a smaller-sized drink.
A valid criticism of Mr. Bloomberg's proposal is that it may ultimately prove to be ineffective. Undoubtedly, the policy can and will be subverted in numerous ways. For example, consumers may shift more of their soft drink buying to neighborhood convenience stores or take greater advantage of free refills. But whether or not the policy will be successful is an empirical question, and that answer will be borne out only with time and careful research.
Ultimately, the mass consumption of high-calorie beverages continues to grow our waistlines, shorten our lives, and siphon off a growing portion of our GDP to healthcare costs. Admittedly, despite New York City Health Commissioner Thomas Farley's estimate that as much as half of the increase in the city's obesity rates over the past three decades has been due to sweetened drinks, there are surely myriad factors responsible. However, rather than throw up their hands, other city and state policymakers should borrow Mr. Bloomberg's approach and nudge more of their own citizens into making better choices. Well thought-out policies that don't succeed will do little harm, while those that do find success can be widely adopted. As it stands, when it comes to obesity, most policymakers are setting a bad example: remaining in their chairs.
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Doubtful. For one, where's the evidence that these large drinks in theaters are what contributes to obesity? What are the sales breakdowns on such beverages? Speaking from personal experience, the only time myself or people I've known have gotten the "super size" beverages in theaters is when we are sharing them with a date, spouse and/or children. It's cheaper that way.
The fact is that "obesity" in the US is largely caused by unhealthy foods being the most affordable to those with the least amount of money, who also often find themselves working hours that don't make time for exercise a reality. Until that is addressed, and the government shows its willing to actually make truly healthy foods regularly available and obtainable by those with $0 in their bank account as is at the end of the month, these "nudging" policies of Bloomberg are symbolic and hollow.
A valid criticism of this article is that it calls citizens "consumers", treats mayors of cities as if they are CEOs of private enterprises, thinks whether policies may or may not be effective is immaterial, and is blind to the free citizen perspective that there is a difference between public health and private health.
Public health has to do with transmission of diseases, or actions of one person which effect the health of another. Every time public health officials have strayed past this definition of public health into private health, always with semantics (it's public health because it costs money!) it has always turned out bad.
Especially when they plan to punish the free citizens, to "encourage" them to do what busy bodies want them to do.
Smoking, well, there was second hand smoke, at least a nail to hang a hat on, as long as the nail holds.
Drinking a softdrink? Can't think how that would hurt me in any way at all.
Not public health, not at all.
How about higher healthcare costs? How about your Coke putting fountain drinks and vending machines in your kids schools pushing them towards early diabetes and an addiction to sugary drinks? Do these not concern you?
What I think about healthcare costs is that we pool our private risks, and that is all.
You want to jump out of an airplane with a parachute? Members of the U.S. Parachute Association reported 821 injuries and 18 deaths out of 2.2 million jumps in 2007. Obviously, that would be 0 injuries and 0 deaths if we outlawed parachuting. But that is not public health.
I started by saying that "Every time public health officials have strayed past this definition of public health into private health, always with semantics (it's public health because it costs money!) it has always turned out bad."
It would be bad to outlaw parachuting on the grounds of public health, on grounds that the injuries and death cost money. Because the injuries and deaths, barring a parachutist crashing into somebody on the ground, do not effect the health of anybody else.
And public health is not concerned with private risk. That pooled risks cost money is not a public health issue.
And the risk in calling pooled risk public health, is that when the authorities need to intervene on the grounds of public health, such as transmission of disease, they are so discredited with their previous attempts to measure and prohibit risk in private health, that they are ignored.
Yet it is the duty of all of us who understand the gravity of the problem to be for this, because it is superior to doing nothing, holding conferences in famous resorts, issuing toothless decrees, voicing "concern" in order to be politically correct while taking graft money from the sugar industry, removing soda from schools while eating sugar and popping unnecessary medications, overburdening our already crippled medical system. I just read a most "weighty" opinion on what we should do from a most corpulent professor (he sported his picture without a second thought - )
How so? Because it raises our awareness and turns our unwilling attention to the issue, so much so that NY mayor Bloomberg has already has been attempted ridiculed in the NY Times - how is that for panic of the profiteers of the sugar-misery who apparently could not pay him off?
Point: We cannot play into the hand of the saboteurs and profiteurs by continuing to do nothing because it "might be ineffective". We have to do something even if it does not work, hoping one day we'll listen to reason and do what must be done.