Mayor Bloomberg’s proposal, announced last month, to ban the sale of sodas and other sugar-sweetened beverages larger than 16 ounces at restaurants, movie theaters and other food service establishments has elicited an avalanche of responses from public health experts, industry representatives, the media and the American public, let alone the New Yorkers who may no longer be able to take a big gulp beginning as early as March 2013.
The responses generally fall into two camps. In one are those who believe that the government has no choice but to intervene given the scale of the obesity epidemic. In the other camp are those who believe that government has no business taking away consumers’ freedom of choice in what they eat or drink.
The Washington Post, for example, applauds the mayor’s initiative: “We are happy to see Mr. Bloomberg experimenting with serious policies to address obesity, which is more than can be said about most of America’s politicians, and we hope he succeeds.” The New York Times, on the other hand, criticizes the mayor for “overreaching”: “The administration should be focusing its energies on programs that educate and encourage people to make sound choices.”
At one time, I would have agreed with the Times editorial board, that educating American consumers is the best way to address the issue. But education by itself isn’t working. More aggressive measures have to be taken, and urgently, as the number of overweight and obese Americans continues to rise. Government has to intervene on behalf of society as a whole. Obesity-related health care costs are at $150 billion, and the costs owing to loss in productivity are estimated to be $164 billion.
“The behaviors that harm our collective health are not, by and large, the result of bad or foolish individual choices,” writes Ronald Bayer, professor at the Mailman School of Public Health at Columbia, in an essay about government intervention published in the Times. “These ‘bad habits,’” he continues, “are shaped by our culture, social arrangements and commercial interests. As a consequence, from a public health point of view, there is a moral imperative to intervene to protect us from decisions that make us sick, shorten our lives and burden our health care system.”
By the force of its marketing prowess, political power and financial resources, Big Food has encouraged bad habits that have led to today’s public health crises. “Any whiff [the mayor's ban] gives off of overzealous government intervention,” argues Frank Bruni, food writer and former Times restaurant critic, “must be seen in the context of the billions upon billions of advertising and marketing dollars spent annually by the fast-food industry on exhorting us to pig out.” Here government has a moral imperative to act on our behalf, to counter Big Food with big public policy.
Why has soda and other sugary beverages become the target of so many anti-obesity campaigns? And what is the rationale behind Bloomberg’s proposal to single out the sale of supersize sodas?
“Sugar-sweetened beverages,” Mark Bittman wrote in the Times, “are nothing more than sugar delivery systems, and sugar is probably the most dangerous part of our current diet.” These beverages can’t be considered food any more than “beer and tobacco and, for that matter, heroin, and they have more in common with these things than they do with carrots.” They contribute 10 percent of the calories in the average American diet, but unlike hundreds of thousands of other processed edibles in our food supply, they are not in the least bit defensible as food, as, that is, a “nutritious substance” that promotes “health and good condition.” They are, moreover, the biggest single source of added sugar in our diets, and sugar, recent research has shown, is an insidious toxin.
Notwithstanding the evidence against sugar-sweetened beverages, what exactly are the merits of this particular proposal banning the sale of supersize portions at food service establishments? It seems a somewhat arbitrary restriction. What will it accomplish? Will it reduce the rate of obesity? Will it induce New Yorkers to drink less soda?
“It’s in many senses an absurd and random gesture,” Bruni writes, since New Yorkers can still buy a 20-ounce milkshake with more calories than a soda or order free refills at a restaurant. A limit on the size of the cup that may be sold and purchased, however, forces people to adjust to a new norm. Bloomberg, Bruni writes, is “trying to reroute our expectations and tweak our habits.”
That, Bayer explains, is what government can do here; it can change the norms that guide our behaviors. It can remind us that it isn’t normal to drink 32 ounces of sugar-loaded liquid in one sitting and that, in fact, it is outrageous to do so. At the same time, we have to continue to ask ourselves: “How far should government go in changing social norms, and what policies should it employ in creating a healthier community? There will be debate. There should be. But it ought to occur with full appreciation of the price we pay for inaction or timidity.”
Regulating Big Food appears to be an impossibility. An alternative is for government to help make our food environment more public health-friendly. It’s not anyone’s first choice, but the price paid for inaction is more than we can afford. The proposed ban may not exactly reverse the obesity epidemic, but at least Bloomberg’s trying.
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