New tactic in war on obesity: Attack portion size


Kim Ward sips an extra large soft drink from McDonald's in the Brooklyn borough of New York City. In an attempt to fight obesity, Mayor Michael Bloomberg has announced plans to ban the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts. (Spencer Platt/Getty Images)
June 2, 2012

After obesity rates in the United States began soaring in the 1980s, federal, state and local governments started to push back.

Calorie counts were mandated for food packages and in many restaurants. School lunches were made healthier. Unhealthful trans fats were phased out.

Yet American waistlines continued to swell, with two-thirds of adults and one-third of children now overweight or obese — a major factor in the country’s health-care crisis, because obesity can trigger expensive chronic illnesses, including diabetes and heart disease.

By the early 2000s, policymakers began focusing their energies on a new target: soft drinks. High in calories and with no nutritional value, sodas are a huge source of added sugar in the American diet. Study after study shows that people who drink the most non-diet soda are at the highest risk for obesity.

But in the face of intense lobbying from drinkmakers, efforts to tax and regulate soft drinks have foundered.

This past week, New York Mayor Michael Bloomberg (I) tried a new tactic: He proposed limiting sugary drinks sold by restaurants, cinemas, street vendors and stadiums in his city to 16 ounces. (Grocery stores would be exempt.)

“We know that portion size
influences consumption,” said Thomas Farley, New York’s health commissioner. “We know that portion sizes have risen dramatically. And we know that sugary drinks have this uniquely strong connection with weight gain.”

The move intensified the debate over how far government should go to steer individual behavior in the name of health and drew immediate scorn from the $75 billion-per-year soft drink industry.

“Here they go again,” said Chris Gindlesperger, spokesman for the American Beverage Association, an industry group. “The New York City health department has an unhealthy obsession with attacking soft drinks. It’s over the top. It’s overreach. The city is not going to address the obesity problem by attacking soda, because soda is not driving the obesity rate.”

A group funded by restaurants began running ads in New York branding Bloomberg — depicted in a dowdy dress with a scarf around his neck — as “the nanny.”

“You only thought you lived in the land of the free,” read the newspaper ad placed by the Center for Consumer Freedom, which sourcewatch.org says represents the restaurant, alcohol, tobacco and other industries.

Fast-food giant McDonald’s weighed in with a tweet to Bloomberg on Friday: “We trust our customers to make the choices that are best for them.”

But public health advocates contend that letting everyone make their own choices has led the country to $192 billion per year in medical bills for obesity-
related care. That’s a tab everyone ends up paying part of via Medicare, Medicaid and soaring rates for private health insurance.

“There is nobody on the face of the planet who needs a soda, let alone a 32-ounce soda,” said Robert Lustig, a pediatric obesity researcher at the University of California at San Francisco who is a vocal proponent of restrictions on sugary drinks.

Advocates of soda regulation point to a long list of government mandates — vaccines to prevent childhood diseases, seat belt laws and air bag rules for cars, high taxes and age restrictions on cigarette and alcohol use — that they say have improved public health and saved lives.

What sets New York’s proposal apart is that it addresses a new aspect of the obesity problem — portion size.

Opening ‘a new front’

“If New York City’s initiative succeeds, it really opens up a new front,” said Michael Jacobson, executive director at the Center for Science in the Public Interest, an advocacy group. “I’m sure it will encourage other cities and states to seek similar measures to reduce portion sizes.”

New York’s Farley said the approach also offers a model for getting around the kind of political warfare that has impeded soda taxes.

The battle over sodas raged in 2009 after President Obama floated the idea of a national soda tax to reduce consumption and pay for health-care reforms. As top academics championed the idea, states and cities rolled out proposed taxes.

But sodamakers pushed back hard. They upped their lobbying expenditures eightfold from 2008 to 2009, to $40 million, according to records for the American Beverage Association.

PepsiCo threatened to move its headquarters out of New York state if an 18 percent tax passed there. (It didn’t.) Despite Obama’s rhetoric, a soda tax never even made it into drafts of the health-care bill, which was passed in 2010. And soda taxes were ultimately defeated in 30 states and several cities, including Philadelphia.

Sodamakers “have indicated they will spend as much money as it takes to kill a tax because tens of millions [of dollars] is nothing compared to the sales they would lose if a stiff tax were adopted,” said Jacobson.

By contrast, adoption of Bloomberg’s proposal is virtually assured. The only body that must sign off on it is the city’s health board — all Bloomberg appointees, with Farley as the chairman.

“New ideas are often more controversial and are more likely to be passed by a group of experts than by a group of people who have to get elected every couple of years,” Farley said.

The beverage industry’s only recourse appears to be a lawsuit, which Gindlesperger said the beverage association is considering.

He also said regulators could achieve more meaningful results if they “came to the table” and negotiated voluntary changes with the industry.

But the sodamakers’ interests are “in complete conflict with public health needs,” said Kelly Brownell, a Yale professor who is a proponent of soda taxes and restrictions.

Big profits from big portions

That’s because drinkmakers and retailers reap big profits from giant drinks, Brownell added. For just a few pennies of extra product, soda companies can sell jumbo drinks for a dollar or two more than smaller sizes.

“That’s why you have to regulate,” he said.

Bloomberg’s proposal swims against two federal policies that public health advocates say encourage soda drinking:

●Farm subsidies that push down the price of high-fructose corn syrup add about $100 million a year to the bottom line of sodamakers, according to a 2009 analysis from Tufts University researchers. Those subsidies make soda cheaper.

●The 42 million Americans receiving federal food stamps use those benefits to buy $4 billion of soda every year, according to the Center for Science in the Public Interest.

Still, per-capita production of sugary drinks dropped 24 percent from 1998 to 2011, according to an analysis from the center. Jacobson called that “historic” and said it “indicates some progress, probably due to a whole range of factors,” including more consumption of bottled water and diet sodas, the popularity of low-carb diets like Atkins, and increased health consciousness.

Experts disagree about whether the Bloomberg plan will cut into the city’s obesity problem.

“There’s not a lot of evidence it will work,” said Brian Wansink, a Cornell University professor who studies food behaviors. “Because the people who drink it really like it, they’re going to figure out a way around it.”

For example, Wansink said, people would just buy two smaller sodas instead of one big one.

But a slew of research shows larger cups and bottles leads to more soda drinking. “What’s put in front of you, big or small, feels satisfying to people,” Farley said.

Barry Popkin, a prominent public health researcher at the University of North Carolina, agreed, calling the proposal “gutsy.”

“Controlling sugary beverage portions . . . is critical for reducing weight gain and risk of diabetes in the United States,” Popkin said.

Brownell dismissed industry groups’ assertions that Bloomberg was curbing Americans’ freedom to choose. “It’s not a nanny state to encourage people not to buy a 64-ounce soda at KFC,” he said.

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