by Marion Nestle

Currently browsing posts about: Soft drinks

Oct 9 2012

Big Soda to put calorie labels on vending machines in city offices in Chicago and San Antonio

Yesterday, Beverage Digest announced that the American Beverage Association (ABA) and its Big Soda members—PepsiCo, Coca-Cola, and Dr Pepper/Snapple—were starting a “new vending machine program to help combat obesity.”

The new “Calories Count Vending Program” starts in 2013 in city buildings in Chicago and San Antonio.

This, Beverage Digest says, “is what can happen when the industry and mayors work together, collaboratively.”   It quotes an executive from Dr Pepper Snapple: “this program is yet another example of how the beverage industry is providing meaningful solutions to help reduce obesity.”

Really?  If these companies really wanted to help reduce obesity, they might start by eliminating sugary drinks.  But never mind.  This is about politics, not health.

For one thing, calorie labels are going to have to go on most vending machines anyway, as soon as the FDA gets around to writing the regulations for them.

For another, this move heads off any attempt to introduce (horrors!) taxes on sodas or caps on bottle size in those two cities.

Chicago Mayor Rahm Emanuel is quite clear about that.  He says his approach to the health issue “is better because it emphasizes personal responsibility.”

He prefers to have Chicago city workers compete with those from San Antonio for a $5 million grant from the ABA.  The ABA has also agreed to pay $1,000 to workers who meet health goals to be determined.

Although this might look like a bribe, Emanuel denies that the program is a payoff:

I believe firmly in personal responsibility,” the mayor said at a City Hall news conference with the pop company executives. “I believe in competition, and I believe in cash rewards for people that actually make progress in managing their health care.”

According to the New York Times, Mayor Emanuel actively sought the ABA grant.

If only personal responsibility worked, alas.  So much evidence now shows that it’s not enough to change behavior.  It is also necessary to create a food environment more favorable to making healthful choices.

That’s the public health approach taken by New York City Mayor Michael Bloomberg .  His approach is to make the food environment more conducive to healthful choices without anyone having to consciously think about them.  This approach is more likely to reduce soda consumption, which is why the ABA wants to head off taxes and caps.

Oh well.  Education is always a good thing, and here’s what the ABA says the vending machines will look like.

Sep 24 2012

Do sugar-sweetened beverages promote obesity? Yes, say papers in the New England Journal.

 The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to  coincide with presentations at The Obesity Society’s annual meeting.  Here are links to the articles.  I’ve extracted brief quotes from some of them.  And here’s a summary in the New York Times.

Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.

Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.

In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….

Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity

The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”

Original Article: J.C. de Ruyter and Others,  A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up

Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?

These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.

Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages

This one is a point/counterpoint.  On the basis of the evidence just presented, should government regulate sugary drinks?

New York City Health Commissioner Tom Farley says yes:

If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7

Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.

David Just and Brian Wansink say no:

We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.

I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.

Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.

The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.

OK city agencies: get to work!

Sep 19 2012

JAMA publishes theme issue on obesity

Yesterday, JAMA released a theme issue on obesity with several articles of particular interest, starting with New York City Health Commissioner Tom Farley’s Viewpoint.  About portion sizes, Dr. Farley notes:

As publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed….The sale of huge portions is driven by the food industry, not by consumer demand….The portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories.  This change will not reverse the obesity epidemic, but it can have a substantial effect on it.

Lots of interesting food for thought here.  Take a look:


Viewpoint

The Role of Government in Preventing Excess Calorie Consumption:  The Example of New York City
Thomas A. Farley, MD, MPH
JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623

The Next Generation of Obesity Research:  No Time to Waste
Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853

FDA Approval of Obesity Drugs:  A Difference in Risk-Benefit Perceptions
Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007

Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931

Original Contribution

Exercise Dose and Diabetes Risk in Overweight and Obese Children:  A Randomized Controlled Trial
Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762

Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461

Health Benefits of Gastric Bypass Surgery After 6 Years
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164

Health Care Use During 20 Years Following Bariatric Surgery
Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792

Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea:  A Randomized Controlled Trial
John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580

Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132

Editorial

Progress in Filling the Gaps in Bariatric Surgery
Anita P. Courcoulas, MD, MPH
JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337

Progress in Obesity Research:  Reasons for Optimism
Edward H. Livingston, MD; Jody W. Zylke, MD
JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203

Sep 18 2012

Today’s debate: The Wall Street Journal asks who’s responsible for preventing obesity?

Betsy McKay of The Wall Street Journal organized and moderated a debate on this question.  I was a participant along with Brian Wansink , the John S. Dyson professor of marketing at Cornell University and Michael D. Tanner, senior fellow at the Cato Institute.

The debate is lengthy—you can read all of it online—but here are my initial responses to the two questions asked of me.

WSJ: What role should government play in addressing the obesity epidemic?  

DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to “eat more” by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The “I am responsible” argument does not work for children (I’m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity—currently estimated at $190 billion a year—governments have many reasons to promote the health of their populations. Just ask the military.

WSJ: Let’s talk about some specific initiatives. Will Mayor Bloomberg’s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink’s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food—and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg’s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg’s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

Sep 10 2012

California judge: Richmond cannot require anti-soda tax group to disclose donors

I’m following the soda tax initiative in Richmond, CA with rapt attention.  Richmond, as I explained last week, is a low-income city with a lot of obesity-related chronic disease and high soda consumption.

Residents will vote on its soda tax initiative in November.  In the meantime, the American Beverage Association has gone to work to spin the science, attack critics, and fund “community coalition” groups to oppose the initiative.

Richmond requires such groups to disclose their top donors on political mailings.  The soda-industry funded “Coalition” went to court to block this requirement on First Amendment grounds.

Now, according to Robert Rogers, the terrific reporter for the Contra Costa Times who has been working on this story, a federal judge in San Francisco issued a temporary restraining order doing just that.

Complete victory for our side,” said coalition spokesman Chuck Finnie. “(Judge Charles Breyer) indicated he doesn’t think (the ordinance) applies to us because we are not engaged in independent expenditures. (Breyer) indicated a city can’t require a campaign to publish political arguments under the guise of claiming it is a disclosure.

This will be back in court on September 18.

In the meantime, “Big Soda” is expected to spend more than a million dollars in Richmond to make its efforts look like a local campaign.

Here is the Statement on Ruling on Richmond Mailer Ordinance.

And here are related Contra Costa Times stories on the soda tax initiative.

Sep 6 2012

Big Soda sues to hide its funding of anti-tax campaign

Sometimes the actions of food companies defy credulity.

Get this: The Community Coalition Against Beverage Taxes, a “grassroots” group funded by the American Beverage Association, has taken the city of Richmond, California to court to block it from requiring disclosure of funding sources in election campaigns.

In case you haven’t been following this situation, the Richmond city council got a soda tax initiative (“Measure N”) placed on the November ballot.

Richmond is a low-income, mixed-race city (80% non-white), with an 11% unemployment rate, and an average household income of $23,000 a year.  It population is largely obese and drinks a lot of sodas.

You would hardly think a city like this would get on the radar of Big Soda, but you would be oh so wrong.

For details, we have to thank Robert Rogers who writes for the local Contra Costa Times.

Mr. Rogers has been following the money.

Because California requires lobbyists to register, he has been able to get hard numbers on the relative spending of anti-tax forces and those who favor the tax.  The difference is impressive.

The city of Richmond must have suspected that something like this would happen because the city council passed an ordinance that requires special interest groups to disclose who funds them in campaign literature.  They must list their top five funders.

You might think this idea entirely appropriate to a democratic society, but the American Beverage Association (translation: Coca-Cola and PepsiCo) does not.

According to Rogers’ account on September 4, Big Soda has sued the city in federal court to stop it from insisting that campaigns disclose who funds them.

On what grounds, pray tell?

The First Amendment, of course.

The suit, filed in federal court in San Francisco on Aug. 30, seeks an order barring the city from imposing its campaign ordinance on the Community Coalition Against Beverage Taxes, a declaration that the groups’ First Amendment rights were violated and money to cover court costs.

The coalition is funded mostly by the American Beverage Association and has spent more than $350,000 locally in an effort to defeat a November ballot measure that could impose a penny-per-ounce tax on sales of all sugar-sweetened beverages in the city.

…Coalition spokesman Chuck Finnie said Tuesday that the law itself is unconstitutional and should not be applied to the anti-soda tax groups.

“The law in question is being enforced to prevent opponents of an unfair, misleading and misguided tax from being able to communicate effectively with Richmond voters,” Finnie said. “The sponsors of the Measure N tax don’t want voters to hear how the tax is going to raise grocery bills, hurt local businesses on which livelihoods depend, and the fact that city politicians would be free to spend all of the money raised by Measure N in any way they see fit and that not one penny must be used to fund anti-obesity efforts.”

In other words, revealing funding sources prevents “effective communication.”

The court will hear this suit on Friday.  Stay tuned.

In the meantime, here are the relevant documents, thanks to Robert Rogers.

Aug 28 2012

PepsiCo donates $100,000 to National Association of Hispanic Journalists

A blog post from Fernando Quintero on the Berkeley Media Studies Group’s site alerted me to PepsiCo’s latest example of corporate social responsibility: an additional $50,000 donation for scholarships and internships to the National Association of Hispanic Journalists bringing the total to $100,000.

Hispanic populations in the United States have higher than average rates of obesity, type 2 diabetes, and other chronic conditions associated with overconsumption of sodas and snacks.

Such generosity raises questions about what Pepsi is buying from this group.

The NAHJ says:

We are thrilled to have PepsiCo as a new partner committed to building a stronger Latino community,” said Ivan Roman, Executive Director for NAHJ. “The company’s support as we get more Hispanics into journalism to tell our stories is key to making sure our communities are represented fairly in the news media, while giving them a louder voice in the civic dialogue.

Why do I think that journalists in this Association are unlikely to be telling stories like these:

  • The relationship of soda and snack consumption to obesity and type 2 diabetes in Hispanic communities
  • The relationship of soda and snack consumption to Hispanic childhood obesity
  • How soda intake among Hispanic children leads to dental decay
  • Soda company marketing practices in Hispanic communities
  • The effects of soda and snack marketing on dietary practices and health in countries in Latin America

Pepsi says:

As part of La Promesa de PepsiCo, the company is building relationships with the community, strengthening its strategic partnerships, and sponsoring national Hispanic organizations like: CHCI (Congressional Hispanic Caucus Institute), HACR (Hispanic Association on Corporate Responsibility), LULAC (League of United Latin American Citizens), NAHJ (National Association of Hispanic Journalists), and NCLR (National Council of La Raza) among others.

A page from the tobacco-industry playbook, no?

Jul 25 2012

Yesterday’s hearing on Big Soda ban

I’m out of town but learned about the hearing by e-mail and twitter (thanks to senders), and I’ve read the coverage in Huffington Post,  the Christian Science Monitor, and the Toronto Star.

One picture says it all:

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