Friday, June 1, 2012

NYC Large Soda Ban: Right Law, Wrong Reasons

So New York City is banning the sale of sugary beverages over 16oz.  ( Bloomberg is touting this as his administration’s way to “do something” about the city’s obesity epidemic, and he claims that sugary drinks are the leading cause of obesity. 

One of my favorite bloggers, Regan at Dances With Fat, recently wrote a post about her opposition to the law (
Regan and I usually agree – in fact, her blog was my primary introduction to Health At Every Size and Size Acceptance.  In this case, though, I strenuously disagree with her.

While I also disagree with everything about the phrase “obesity epidemic,” I do think this law is a good idea.

Now, don’t get me wrong, Bloomberg’s obesity-based justification for the law is problematic.   In fact, he should just stop talking.

Obesity is not a health problem, it’s a body size. When people talk about the “health consequences of obesity” what they really mean to address (I hope) are the health consequences of sedentary lifestyle and poor diet.  Conflating obesity with poor diet and lack of exercise is problematic for several reasons.  First, good diet and lots of exercise don’t necessarily make obese people thin.  Secondly, plenty of thin people have a bad diet and get no exercise – these people are not healthy by virtue of being thin, they’re just smaller.  Thirdly, you’ve muddied your discussion of an important public health issue with the rhetoric of anti-fat prejudice.

So let’s just leave obesity out of it.  Poor diet is still a public health problem.  It’s a public health problem that affects people of all sizes – the consumption of thousands of calories of sugar-water is not good for you, whether it leads to weight gain or not. 

A 2007 meta-analysis (Vartanian, et al. “Effects of Soft Drink Consumption on Nutrition and
Health: A Systematic Review and Meta-Analysis,” American Journal of Public Health) found that increased soda consumption led to increased caloric intake over and above the calories in the soda itself, suggesting that soda consumption stimulates the appetite or affects satiety.  Increased soda consumption was also associated with decreased milk and calcium consumption.

In terms of health outcomes, daily soda drinkers had double the risk of developing type 2 diabetes compared to infrequent soda drinkers.  This was true even when controlling for BMI.  Let me say that again - the behavior of drinking soda was associated with increased risk of developing type 2 diabetes, regardless of weight.  Skinny soda-drinkers – you are not safe!

So type 2 diabetes is no fun.  It is a legitimate public health issue.  In fact, I might even let Bloomberg call this one an epidemic.

So soda is not a benign substance – what is the best way to address that?  One ever-popular approach is to encourage individuals to “make good choices.” (Can’t you just hear Michelle Obama’s voice saying this?)

“Making good choices,” is appealing to Americans, because we tend to believe in this fantastical individualism myth – individuals can pull themselves up by their bootstraps, it’s the American dream, etc, etc.  (The more conservative you are, the more likely you are to subscribe to this worldview). 

Regan argues the other side of the individualism argument, asserting that people have the right to prioritize or not prioritize their health.  This comes up a lot in her blog, where she argues that while it is possible to be fit and fat, it is also not the responsibility of every fat person to be fit; that fat people have just as much right to have unhealthy habits as thin people.  And in general, I agree, that individuals have the right to prioritize health as they see fit for themselves; but as a public health scholar, I am interested in maximizing the health of populations.

And I take issue with the idea that freedom means being able to buy a Double Big Gulp.  New York banning large sodas is not the nanny state restricting individual freedom.  It’s a public health measure countering the enormous marketing pressure of the beverage industry.  Your choice to buy a Double Big Gulp isn’t a free choice, it cost Coca-Cola many billions of dollars in clever polar bears, dancing young people, and a cultivated Pavlovian response to their red logo. 

Individuals can’t realistically resist a mammoth like Coca-Cola using will-power alone.  Instead, systemic unhealthy influences are best countered by public policy.  And the large soda law is a great example of putting the pressure in the right place, not on the consumer, but on the seller. (I’d love to see the law targeting the beverage companies themselves, but at a city-wide level, targeting restaurants is probably as high up the food chain as they can go.)

Regan argues that using the obesity justification for this law will make thin people resent fat people for restricting their choices.  I agree the obesity justification for this law is terrible.  But the whole anti-obesity campaign is terrible.  Thin people already resent fat people.  Fat people are blamed for everything from health care costs to global warming. 

So yes, it is important to resist anti-obesity rhetoric.  But pitting Size Acceptance against public health is not the way to go.  A broader understanding of both Size Acceptance and public health reveals that Size Acceptance is public health – it’s a movement advocating for the improved social standing and mental health of 2/3 of American adults.