by Marion Nestle

Currently browsing posts about: Portion sizes

Mar 10 2013

Daily News Op-Ed: Bloomberg’s soda ‘ban’ should be only the beginning

My double-page op-ed in today’s New York Daily News:

Liberty from big soda: Why Bloomberg’s ‘ban’ should be only the beginning of a public health revolution

 

 

 

Barring any late legal surprises, Mayor Bloomberg’s 16-ounce cap on sugary sodas goes into effect on Tuesday, March 12. After that, restaurants, movie theaters, sports venues and food carts will not be permitted to sell extra-large portions of sugar-packed drinks.

Stay calm. This does not signal the end of democracy in America. This is not the nanny state gone out of control.

If we want Americans to be healthy, we are going to have to take actions like this – and many more – and do so soon. It’s long past time to tax sugar soda, crack down further on what gets sold in our schools, tackle abusive marketing practices, demand a redesign of labels – and extend the soda cap, no matter how controversial it may seem. This must be the beginning, not the end, of efforts toward a healthier America.

In short, we need a series of serious changes to make the healthy choice the easy choice. The soda size cap is a nudge in that direction. You will still be able to drink all the soda, and down all the sugar, that you want. The cap on soda size makes it just a tiny bit harder for you to do so.

That “tiny bit harder” is its point. If you have to order two sodas instead of one, maybe you won’t. If you have to add sugar to your coffee drink yourself, maybe you will only add one or two teaspoons instead of the 10 or more someone else put in there for you.

For a public health nutritionist like me, the soda size cap is a terrific idea. Unlike other foods, sodas are a unique target for intervention. They contain sugars – and sugar calories – but nothing else of nutritional value. They are candy in liquid form. Candy has a place in healthy diets, but a small one. So it should be for sodas.

It’s no surprise that people who drink large amounts of liquid candy have worse diets, are heavier, and have more health problems than those who do not. And it looks like the body doesn’t compute the calories from liquid sugars as accurately as it does for sugars in foods.

On top of that, big sizes make the problems worse. To state the obvious, larger portions have more calories. If an 8-ounce soft drink provides 100 calories, then a 16-ounce drink provides 200, a 32-ounce drink provides 400 and a 64-ounce drink provides 800.

But big sizes also have other effects. They induce people to eat and drink more than they would if given smaller portions. Big sizes confuse people into underestimating the number of calories consumed.

Most people eat whatever size is in front of them – the “default,” in public health-speak – and are content with that amount. So a reasonable goal of public health intervention is to change the default drink to a smaller size. Hence: Bloomberg’s 16-ounce size cap.

From my nutritionist’s perspective, a 16-ounce soda is still generous. Just one contains the equivalent of 12 packets of sugar. Just one provides 10% of the daily calorie needs of someone who typically eats 2,000 calories a day. Just one contains the upper limit of sugar intake that health officials recommend for an entire day. Once you down a 16-ounce soda, it’s best to stop right there.

You may find this hard to believe, but the original Coca-Cola was 6.5 ounces, smaller than any size available today. In the 1950s, Coke advertised its 16-ounce bottle as large enough to serve three.

Times have changed. The sizes of foods and drinks have expanded, and so have waistlines. This is no coincidence. On the basis of calories alone, larger portions are all you need to explain why Americans are putting on pounds.

City officials concerned about the health of their citizens, as those in New York most definitely are, want to do everything they can to prevent obesity and the illnesses that go with it. Their rationale is humanitarian, but also fiscal. Poor health is expensive for both individuals and society. You don’t believe that excessive weight is an issue? Just ask the military.

We can thank Big Soda – Coca-Cola, Pepsi and their trade association, the American Beverage Association – for the contribution of big sodas to weight gain. Soda companies have spent fortunes to create demand, to make drinking large amounts seem normal, to market sodas as essential for health and happiness and, these days, to fight Bloomberg’s soda cap and take the city to court over it.

Soda companies may make things you like to drink, but they are not social service agencies. Their job is to get you to buy more soda to satisfy the financial demands of investors. They are about business. They are not about fun or happiness or personal choice – and they certainly are not about health.

The soda industry may profess to care more about your well-being these days, but it ultimately will not do anything to promote health if doing so harms sales.

So-called “nanny-state” measures – like bans on driving while drunk, smoking in public places and, now, selling absurdly large sugary drinks – help to level the playing field. Such measures are about giving everyone an equal opportunity to live a safer and healthier life.

At the moment, it is up to you to make healthier choices, but that’s not easy in the face of relentless soda marketing. Governments have a responsibility to provide healthier environments for their citizens.

Here are some additional actions New York City should take, if only it were allowed to.

Close the loopholes. The city does not have jurisdiction over sales of sodas in convenience stores and supermarkets. The state does. Gov. Cuomo denied Mayor Bloomberg’s request to extend the size cap to those stores, not on principle but because he hadn’t thought about it. He should, right now. Let’s keep all sugary drinks to 16 ounces or less.

Fix the price differential. A 7.5-ounce can of soda costs twice as much per ounce as a two-liter bottle, and you can’t buy just one; it comes in an 8-pack. Price determines sales. If a 16-ounce soda costs a dollar, a 32-ounce soda should cost two dollars.

Tax sodas. Most people wouldn’t dream of eating candy all day, but soda companies have made it seem normal to drink sodas from morning to night. Raising the price of sodas would discourage sales, especially among young people most susceptible to marketing efforts and most vulnerable to weight gain. A one-cent tax per ounce should do the trick and raise plenty of needed revenue besides.

Remove vending machines from schools. Yes, the Beverage Association only puts “better-for-you” drinks in school vending machines, but sugar-filled sports drinks are still liquid candy. And kids should not have to pay for water in schools.

Restrict marketing of sodas to children. Soda companies market extensively to children and adolescents, especially those in low-income neighborhoods. Just look at billboards, celebrity photos on soda cans and Pepsi’s $50 million dollar deal with Beyoncé. They should not be permitted to market to kids this way. We already have restrictions on cigarette and alcohol marketing to kids. It breaks no new ground to add sodas to the list.

Don’t let SNAP (food stamp) benefits be used for sodas. Bloomberg tried this, but the federal Department of Agriculture said no. There is absolutely no reason that taxpayer-subsidized food assistance for low-income people should go toward junk with no nutritional value. He should try again.

Show full calories on the front of containers. The current way calories are tallied, in a measure called “calories-per-serving,” is confusing because the servings are unrealistically small and people don’t do the math. Soda cans already give the full calories in tiny type on the Nutrition Facts label, but I want to see the full calories in big type on the front.

Actions like these will evoke ferocious opposition from the soda industry, and it will spare no expense to make sure such things never happen. We would surely hear more and more howls of “nanny-state” from those who insist Bloomberg has led us to the brink of a public health police state. Polls say that many New Yorkers oppose the 16-ounce cap and would oppose measures like this, too.

But I can’t tell whether the opposition comes from genuine concern about limits on personal choice or because soda companies have spent millions of dollars to protect their interests and gin up histrionic, misinformed opposition.

Come Tuesday, the 16-ounce soda is the new default size in New York City. While waiting for the court decision and for politics to play out, why not give it a chance? Maybe it will help you live a healthier and longer life.

 

Feb 3 2013

Soda-size cap is a public health issue

Here’s my monthly (first Sunday) Food Matters column from the San Francisco Chronicle. The question (edited) came from a reader of this blog.

Q: You view New York City’s cap on any soda larger than 16 ounces as good for public health. I don’t care if sodas are bad for us. The question is “Whose choice is it?” And what role should the nanny state play in this issue?

A: Your question comes up at a time when the New York State Supreme Court is hearing arguments about whether New York City’s health department has the right to establish a limit on soda sizes.

As an advocate for public health, I think a soda cap makes sense. Sixteen ounces provides two full servings, about 50 grams of sugars, and 200 calories – 10 percent of daily calories for someone who consumes 2,000 calories a day.

That’s a generous amount. In the 1950s, Coca-Cola advertised this size as large enough to serve three people.

You may not care whether sodas are bad for health, but plenty of other people do. These include, among others, officials who must spend taxpayer dollars to care for the health of people with obesity-related chronic illnesses, employers dealing with a chronically ill workforce, the parents and teachers of overweight children, dentists who treat tooth decay, and a military desperate for recruits who can meet fitness standards.

Poor health is much more than an individual, personal problem. If you are ill, your illness has consequences for others.

That is where public health measures come in. The closest analogy is food fortification. You have to eat vitamins and iron with your bread and cereals whether you want to or not. You have to wear seat belts in a car and a helmet on a motorcycle. You can’t drive much over the speed limit or under the influence. You can’t smoke in public places.

Would you leave it up to individuals to do as they please in these instances regardless of the effects of their choices on themselves, other people and society? Haven’t these “nanny state” measures, as you call them, made life healthier and safer for everyone?

All the soda cap is designed to do is to make the default food choice the healthier choice. This isn’t about denial of choice. If you want more than 16 ounces, no government official is stopping you from ordering as many of those sizes as you like.

What troubles me about the freedom-to-choose, nanny-state argument is that it deflects attention from the real issue: the ferocious efforts of the soda industry to protect sales of its products at any monetary or social cost.

The lawsuit against the soda cap is a perfect example. It is funded by the American Beverage Association, the trade association for Coca-Cola, PepsiCo and other soft-drink companies, at what must be astronomical expense.

To confuse the public about corporate profits as a motive, the beverage association enlisted two distinguished civil rights groups – the NAACP and the Hispanic Federation – to file an amicus brief on behalf of its lawsuit.

Never mind that the obesity rate for the communities these groups represent is considerably higher than average in New York City, and that these neighborhoods would benefit most from the soda cap. The amicus brief argues that the soda cap discriminates against them.

The brief, however, neglects to mention that both amicus groups received large donations from soda companies and that the NAACP in particular has a long history of partnership with Coca-Cola.

Financial arrangements between soda companies and ostensibly independent groups demand scrutiny. National and local reporters – bless them – have done just that.

They report, among other connections, that one of the law firms working for Coca-Cola wrote the amicus brief, and that a former president of the Hispanic Federation just took a job with that company.

Last fall, the East Bay Express exposed how the soda industry exploited race issues to divide the electorate and defeat the Measure N soda tax initiative in Richmond. It revealed

that the beverage association not only paid for the successful “grassroots” campaign against Measure N but also encouraged views of the soda tax as racist.

Driven by this experience, the soda industry is repeating this tactic in New York City.

Is a cap on soda sizes discriminatory against groups working for civil rights? Not a chance.

Public health measures are about alleviating health disparities and giving everyone equal access to healthy diets and lifestyles. This makes public health – and initiatives like the soda cap – broadly inclusive and democratic.

If anything is undemocratic and elitist, it is suing New York City over the soda cap.

In funding this lawsuit, the soda industry has made it clear that it will go to any length to protect its profits, even if it means discrediting the groups that would most benefit from this rather benign public health initiative.

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

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:

Jul 24 2012

The Bloomberg soda initiative: soda companies fight back, overtly and covertly

The hearing on Bloomberg’s soda volume limit takes place today.  I’m traveling and sorry to miss it (I filed comments).

I shouldn’t be surprised but I am stunned by the intensity and depth of soda industry pushback on this, most of it going on and on about the virtues of personal choice, as if container size has nothing to do with the amount people eat.  It does (see below).

In addition to what reporters have been reporting, here’s what I’ve seen personally:

  • A phony “grassroots”petition campaign paid for by the soda industry with campaigners paid $30 per hour to collect signatures
  • A mailing to my home asking me to protest
  • Handout cards
  • Subway posters
  • Tee shirts
  • And highly visible ads on trucks.

And then there’s yesterday’s op-ed in the Wall Street Journal from Seth Goldman, the “TEA-EO” of Honest Tea:

I challenge the mayor and the New York City Board of Health to seriously consider the impediments that entrepreneurs already face in our efforts to offer lower-calorie drinks. Starting a business and building a challenger brand with modest resources is already a daunting task. The proposed ban would create additional barriers to beverage innovation.

Only one thing wrong with this.  Mr. Goldman must have forgotten to mention that since March 2011, Honest Tea has been a wholly owned subsidiary of Coca-Cola.

Yes, I know the petition has gathered 75,000 signatures or so.  The campaigners and signers should all know better.  See this, for example:

Jul 2 2012

Soda taxes and other measures designed to fight obesity

My once-a-month (first Sunday) Q and A column in the San Francisco Chronicle deals with recent city initiatives.

Q:Why do municipalities continue to try to tell us what to eat or drink through taxes (the 1-cent soda tax on the Richmond ballot in November) or outright bans (eliminating super-size soft drinks, proposed by Mayor Michael Bloomberg in New York)?  Richmond residents could just buy their sodas in neighboring towns, and 1 cent seems hardly enough to influence anyone. New Yorkers could just buy two drinks if they want more. Isn’t this all rather silly?

A: Silly? On the contrary. These are dead-serious attempts to address the health problems caused by obesity through “environmental” change – changing the context in which we make food choices.

By now, health officials are well aware that asking individuals to take responsibility for making their own healthy food choices hasn’t got a prayer of success in the face of a marketing environment that encourages people to eat everywhere, all day long, in very large portions and at relatively low cost.

This is the default food environment, where it’s useless to tell people they need to eat less and expect them to do it. They can’t. Instead, it makes sense to try to change the food environment to make healthy choices the easy choices.

Healthy by design?

Suppose, for example, that all kids’ meals at fast-food restaurants were healthy by design and automatically provided milk or water.

You could still order a soda for your kid, but you would have to ask for it – and pay extra. If you are like most people, you won’t bother. That’s why the default matters.

Cities are trying to change the default. One change may or may not make a difference – we don’t know that yet. But changing the default might well make healthy choices easier in schools, fast-food restaurants and other institutions.

Bloomberg’s proposal in New York, to ban sodas larger than 16 ounces, is one such step. From my standpoint, 16 ounces is generous. It’s two full servings and provides about 50 grams of sugars, 200 calories and 10 percent of daily calories for someone who consumes 2,000 calories a day.

Portion sizes used to be a lot smaller. Decades ago, Coca-Cola advertised 16-ounce bottles as “big” and enough to serve three over ice.

If we could recognize that larger portions have more calories – and act on this knowledge – we might have an easier time maintaining weight. But we can’t, at least not easily.

The Richmond soda tax proposal recognizes that more than half of Richmond schoolchildren are overweight or obese. This percentage is higher than in other areas of Contra Costa County.

Even more striking, city officials estimate that two-thirds of Richmond adolescents consume more than 400 calories a day from soft drinks.

Kids who habitually drink sugary sodas tend to have worse diets, to be fatter and to display more risk factors for chronic diseases than kids who don’t.

This makes sugar-sweetened beverages an obvious target for environmental approaches to obesity prevention. Sugary sodas have calories but no nutrients. They are consumed in large amounts. They are highly correlated with obesity and health risks. They are “liquid candy.”

Sugary drinks should be once-in-a-while treats, not daily fare.

Richmond officials hope that the tax will encourage healthier choices. They deliberately set the proposed tax small so it would not unduly burden low-income residents.

One penny per ounce – 16 cents on a 16-ounce soda – may not be enough to change behavior, but it sends a clear message: It’s less expensive to drink water, and it’s healthier to reduce soda intake.

Funding programs

The Richmond proposal has one other critically important feature. It specifies that soda tax revenue will be used to fund city programs to address and reduce childhood obesity, especially in low-income areas where obesity rates are high.

These experiments are worth national attention. They may well do some good for individuals, and I can’t see how they would cause harm in any way except, perhaps, to the economic interests of soda companies.

Soda companies are taking these initiatives seriously. They are pouring millions of dollars into lobbying and community campaigns against both proposals.

Both have elicited plenty of public discussion, much of it focused on the rights of individuals versus the public health interests of government.

What I like about these initiatives is that they do not infringe on individual rights – people can buy as much soda as they want. The proposals simply try to make the default food environment slightly more conducive to healthy choices.

I’m hoping both proposals go forward. I can’t wait to see how they play out.

Feb 24 2012

Nutritionist’s notebook: Portion Control

I’ve just agreed to write a Q and A column, Nutritionist’s Notebook, for NYU’s student newspaper, the Washington Square News (WSN).  The columns will appear on Tuesday.   This first one was published on February 22.

This week, WSN welcomes professor-columnist Marion Nestle. A Paulette Goddard professor of Nutrition, Food Studies and Public Health at NYU, Nestle also co-authored the recently published book “Why Calories Count: From Science to Politics.” Each week, she will answer student questions about nutrition, health and food.

Question:

What is the importance of size in our portions? What is the best way to judge portions when going out to dinner?

Answer: 

Easy. Large portions make you eat more. If I could teach just one thing about nutrition, it would be this: larger portions have more calories. Funny? Portion size is anything but obvious. Research repeatedly confirms that larger food servings not only provide more calories but also have two other effects. They encourage people to eat more and to underestimate how much they are eating.

A few years ago, I asked Lisa Young, who teaches our department’s introductory nutrition course, to ask her students to guess the number of calories in an eight-ounce Coke and a 64-ounce Double Gulp — yes, such things exist. She did not expect beginning students to know the exact numbers, but did expect them to do the math. To her surprise, the average multiplier turned out to be 3, not 8. How come? Students said that 800 calories in a drink was impossible. No, it is not, as menu labels now reveal.

How to deal with the portion size problem? Use small plates and cups in the dining hall. When eating out, order appetizers, not entrees. Order the small size, or share large portions with friends.

The system is stacked against you and it’s up to you to figure out how to cope with it. Small sizes, for example, usually cost relatively more.

For a long time, I’ve wanted restaurant owners to give a price break for smaller portions. No luck. They say this would put them out of business. We need to make it easier for people to choose smaller portions, which means changes in public policy.

A version of this article appeared in the Tuesday, Feb. 21 print edition. Marion Nestle is a professor/contributing columnist. To submit your questions, email her at dining@nyunews.com.

Jan 9 2012

New York CIty Health Department launches portion-size campaign

The amazing New York City Health Department, almost unique in its interest in public health and willingness to do what it can to improve the health of New Yorkers, adds another campaign to its collection of hard hitters.  This one is on the need to reduce portion sizes.

The subway campaign posters in Spanish and English.  Here’s an example in Spanish.

I especially like this campaign because much of the work on increasing portion sizes in the food supply was launched by my former doctoral student, now Dr. Lisa Young.  See:

Larger portions do three things:

  • They have more calories, obviously.
  • They induce people to eat more calories
  • They induce people to underestimate the number of calories they are eating

All of these induce people to eat more than they need or should.

The expansion of portion sizes alone is sufficient to explain rising rates of obesity.

The Health Department’s campaign makes sense.  Let’s hope it helps.

Update, January 10: The American Beverage Association doesn’t like the ads much, according to Crain’s:

Portion control is indeed an important piece of the solution to obesity,” said said Stefan Friedman, New York spokesman for the American Beverage Association, in a statement. “But instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families.

And if you think the New York City ads are tough and hard-hitting, try these “Strong4Life ads from the state of Georgia.  Shocking people out of complacency?  Or just shocking?

Update, January 25: The New York Times reports that the shocking photograph of an overweight man with a leg amputation was “photoshopped” from a stock photo.

This is unfortunate, as it opens the Health Department up to unnecessary criticism:

The American Beverage Association, which opposes the city’s efforts against sodas and fast food, called the advertisement overwrought. “This is another example of the ‘What can we get away with?’ approach that shapes these taxpayer-funded ad campaigns,” Chris Gindlesperger, the association’s director of communications, said in a statement.