Downsizing the mega-soda

If there was any doubt that New York City was serious about downsizing the giant sugary drinks sold at restaurants and concession stands, it was erased Thursday with the enactment of a new rule by the city’s Board of Health.

The rule places a 16-ounce limit on the size of non-diet sodas, sweetened teas and other sugar-laden drinks sold at restaurants, theaters, workplace cafeterias and other venues that offer prepared food.

Many public health experts have wrung their hands over the amount of sugared beverages consumed by the average American. Few entities, though, have gone so far as to impose an outright ban on super-sized drinks.

Those who support the measure see it as an important – and pioneering – step for public health. Here’s the take by the Associated Press:

They say the proposal strikes at a leading cause of obesity simply by giving people a built-in reason to stop at 16 ounces: 200 calories, if it’s a regular Coke, compared to 240 in a 20-ounce size. For someone who drinks a soda a day, the difference amounts to 14,600 calories a year, or the equivalent of 70 Hershey bars, enough to add about four pounds of fat to a person’s body.

Beyond the numbers, some doctors and nutrition experts say the proposal starts a conversation that could change attitudes toward overeating. While there are many factors in obesity, “ultimately it does come down to culture, and it comes down to taking some first steps,” said Dr. Jeffrey Mechanick, a Mount Sinai School of Medicine professor who has studied the effect of government regulation on the obesity epidemic.

The ban goes into effect March 13, assuming it isn’t struck down before then.

Supporters of the measure have a point. Soft drinks are large and getting larger. Consider the 7-Eleven Big Gulp series: The Double Gulp contains 50 (!) ounces – more than the capacity of the average human stomach. We have become culturally accustomed to supersized portions of everything from soft drinks to french fries to bagels, with the result that it’s increasingly difficult to gauge what a normal-sized serving should be.

But here’s the big question: Will New York’s ban on the largest sugary drinks actually make a difference in people’s health? The answer is not at all clear.

For one thing, the rule contains a multitude of exceptions. It doesn’t apply to beverages sold in retail grocery stores, vending machines or most convenience stores, allowing people to continue to buy their favorite large sizes without restriction.

It exempts beverages that are 100 percent fruit or vegetable juices, even though these can be, ounce for ounce, almost as full of sugar as a soft drink. (For a comparison, check out this chart compiled by the federal government; a 12-ounce serving of grape juice contains 12 teaspoons of sugar – more than a same-sized serving of either cola or root beer.)

Nor is there anything in the rules that prohibits consumers from short-circuiting the intent by simply buying more smaller drinks to equal a large one. And New Yorkers can continue to drink as much soda in the privacy of their homes as they please (at least for now).

Although this is, strictly speaking, a New York City story, it matters to the rest of us as well. Indeed, the Board of Health’s action has captured wide interest across the United States. Seattle lies the width of the continent from Manhattan, but when the Seattle Times offered an online poll on what readers thought of a similar ban in their own city, folks were quick to weigh in.

There’s considerable – and valid – debate over whether regulation and government enforcement are an appropriate strategy for influencing health-related behavior.

Ethically speaking, it’s a murky area. Should government be making people’s food choices for them? Do consumers have the right to make their own decisions about what they buy and drink, or is this outweighed by the public health impact? If the target today is sugared drinks, what’s going to be next?

In the months before the New York City Board of Health voted on the mega-soda ban, a handful of studies attempted to quantify what the health results might be. In one study that involved analyzing the receipts of 1,600 fast-food customers on the East Coast, researchers concluded that if everyone who had been buying a large-sized drink cut back to a single 16-ounce beverage, they would consume 63 fewer calories per meal. But at least 40 percent of consumers had to take this step, otherwise the impact would be negligible, concluded the study.

Finally, banning giant-sized drinks at some commercial venues does little to address other areas of health-related behavior that may be just as important – physical activity, stress, alcohol use and timely access to appropriate medical care, to name just a few.

It’s going to be interesting to watch how the soda ban plays out. Perhaps this is what it takes to begin changing a community environment into one that fosters better health – the proverbial snowball that gathers speed and mass as it rolls downhill. On the other hand, this is still an experiment with unknown results. It’s to be hoped that the New York City Board of Health will watch this closely and collect some real evidence to help decide whether it was worthwhile or not.

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