Search results: soft drink tax

Last week’s New England Journal of Medicine weighs in with several commentaries and research articles.  Some of these were published earlier in online versions:

• Candy at the Cash Register — A Risk Factor for Obesity and Chronic Disease, D.A. Cohen and S.H. Babey | N Engl J Med 2012;367:1381-1383
• Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices, J.L. Pomeranz and K.D. Brownell | N Engl J Med 2012;367:1383-1385 | Published Online September 21, 2012
• Sugar-Sweetened Beverages and Genetic Risk of Obesity, Q. Qi and Others | N Engl J Med 2012;367:1387-1396 | Published Online September 21, 2012
• A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children, J.C. de Ruyter, M.R. Olthof, J.C. Seidell, and M.B. Katan | N Engl J Med 2012;367:1397-1406 | Published Online September 21, 2012
• A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight, C.B. Ebbeling and Others | N Engl J Med 2012;367:1407-1416 | Published Online September 21, 2012
• Calories from Soft Drinks — Do They Matter? S. Caprio | N Engl J Med 2012;367:1462-1463 | Published Online September 21, 2012
• Regulation of Sugar-Sweetened Beverages,T. Farley, D.R. Just, and B. Wansink | N Engl J Med 2012;367:1464-1466 | Published Online September 21, 2012

And this week, it has another on using tax strategies to promote public health.

• Perspective: The Taxing Power and the Public’s Health, M.M. Mello and I.G. Cohen /October 17, 2012 | DOI: 10.1056/NEJMp1209648

It looks to me as though the health establishment is finally catching on to what obesity is really about and giving serious thought to what to do about it.  This is important work.

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

In what Obama Foodorama calls “a fundamental shift in the Let’s Move campaign” Michelle Obama announced in a speech last week that she will now focus on getting kids to be more active.

Apparently, she has given up on encouraging food companies to make healthier products and stop marketing junk foods to kids.

This shift is troubling.  Here’s why:

1.  The shift is based on faulty biology.

To lose weight, most people have to eat less whether or not they move more.   For example, it takes about three miles of walking to compensate for the calories in one 20-ounce soda.

Activity is important for health, but to lose or maintain weight, kids also need to eat less.  Sometimes they need to eat much less.  And discouraging them from drinking sugary sodas is a good first step in controlling body weight.

But eating and drinking less are very bad for business.  Food companies do all they can to oppose this advice.

2.  It undercuts healthy eating messages.

On the one hand, Mrs. Obama says that she disagrees with this assumption: “kids don’t like healthy food, so why should we bother trying to feed it to them.”

But her speech implies that kids won’t eat healthfully unless forced to:

I want to emphasize that last point — the importance of really promoting physical activity to our kids…This isn’t forcing them to eat their vegetables. (Laughter.) It’s getting them to go out there and have fun.

3.  It declares victory, prematurely.

Mrs. Obama says:

Major food manufacturers are cutting sugar, salt and fat from their products. Restaurants are revamping kids’ menus and loading them with healthier, fresher options. Companies like Walgreens, SuperValu, Walmart, Calhoun’s Grocery are committing to build new stores and to sell fresh food in underserved communities all across this country.

Congress passed historic legislation to provide more nutritious school meals to millions of American children. Our schools are growing gardens all over the place. Cities and towns are opening farmers markets. Congregations are holding summer nutrition programs for their kids. Parents are reading those food labels, and they’re rethinking the meals and the snacks that they serve their kids.

So while we still have a long way to go, we have seen so much good progress. We’ve begun to have an impact on how, and what, our kids are eating every single day.  And that is so important. It’s so important.

Really?  I’d say we’ve seen promises from food companies but remarkably little action.

Mrs. Obama’s speech fails to mention what I’m guessing is the real reason for the shift: “Move more” is not politically loaded.  “Eat less” is.

Everyone loves to promote physical activity.  Trying to get the food industry to budge on product formulations and marketing to kids is an uphill battle that confronts intense, highly paid lobbying.

You don’t believe this?  Consider recent examples of food industry opposition to anti-obesity efforts:

• Soda companies successfully defeated efforts to impose taxes on soft drinks.
• Food companies successfully defeated efforts by four federal agencies to set voluntary standards for marketing foods to children.
• Food companies successfully lobbied Congress to pass a law forbidding the USDA from setting standards for school meals regarding potatoes, tomato sauce, and whole grains.  The result?  Pizza tomato sauce now counts as a vegetable serving.
• McDonald’s and  Burger King evaded San Francisco’s new rules restricting toys with kids meals by selling the toys separately for ten cents each.

The political cost of fighting the food industry is surely the reason for the change in Mrs. Obama’s rhetoric.  Now, she agrees that kids won’t eat vegetables unless forced to.

But in March 2010 Mrs. Obama warned Grocery Manufacturers Association:

We need you…to entirely rethink the products that you’re offering…, the information that you provide about these products, and how you market those products to our children….This isn’t about finding creative ways to market products as healthy.

The food industry understood those as fighting words.  It fought back with weapons at its disposal, one of which is to deflect attention from food by focusing on physical activity.   It now has White House endorsement of this deflection.

I’m all for promoting physical activity but the refocusing is a loss, not a win, in the fight against childhood obesity.

In what Bloomberg News terms an “epidemic battle,” food companies are doing everything they can to prevent the United Nations from issuing a statement that says anything about how food marketing promotes obesity and related chronic diseases.

The U.N. General Assembly meets in New York on September 19 and 20 to develop a global response to the obesity-related increase in non-communicable, chronic diseases (cancer, cardiovascular disease, respiratory disease, type 2 diabetes) now experienced by both rich and poor countries throughout the world.

As the Bloomberg account explains,

Company officials join political leaders and health groups to come up with a plan to reverse the rising tide of non- communicable diseases….On the table are proposals to fight obesity, cut tobacco and alcohol use and expand access to lifesaving drugs in an effort to tackle unhealthy diets and lifestyles that drive three of every five deaths worldwide. At stake for the makers of snacks, drinks, cigarettes and drugs is a market with combined sales of more than $2 trillion worldwide last year.

Commenting on the collaboration of food companies in this effort:

“It’s kind of like letting Dracula advise on blood bank security,” said Jorge Alday, associate director of policy with World Lung Foundation, which lobbies for tobacco control.

The lobbying, to understate the matter, is intense.  On one side are food corporations with a heavy financial stake in selling products in developing countries.  Derek Yach, for example, a senior executive of PepsiCo, argues in the British Medical Journal that it’s too simplistic to recommend nutritional changes to reduce chronic disease risk.  [Of course it is, but surely cutting down on fast food, junk food, and sodas ought to be a good first step?]

On the other side are public health advocates concerned about conflicts of interest in the World Health Organization.  So is the United Nations’ special rapporteur for  the right to food, Olivier De Schutter.  Mr. De Schutter writes that the “chance to crack down on bad diets must not be missed.”

On the basis of several investigative visits to developing countries,  De Schutter calls for “the adoption of a host of initiatives, such as taxing unhealthy products and regulating harmful food marketing practices…Voluntary guidelines are not enough. World leaders must not bow to industry pressure.”

If we are serious about tackling the rise of cancer and heart disease, we need to make ambitious, binding commitments to tackle one of the root causes – the food that we eat.

The World Health Organization’s (WHO) 2004 Global Strategy on Diet, Physical Activity and Health must be translated into concrete action: it is unacceptable that when lives are at stake, we go no further than soft, promotional measures that ultimately rely on consumer choice, without addressing the supply side of the food chain.

It is crucial for world leaders to counter food industry efforts to sell unbalanced processed products and ready-to-serve meals too rich in trans fats and saturated fats, salt and sugars. Food advertising is proven to have a strong impact on children, and must be strictly regulated in order to avoid the development of bad eating habits early in life.

A comprehensive strategy on combating bad diets should also address the farm policies which make some types of food more available than others…Currently, agricultural policies encourage the production of grains, rich in carbohydrates but relatively poor in micronutrients, at the expense of the production of fruits and vegetables.

We need to question how subsidies are targeted and improve access to markets for the most nutritious foods.…The public health consequences are dramatic, and they affect disproportionately those with the lowest incomes.

In 2004, the U.N. caved in to pressures from food companies and weakened its guidelines and recommendations.  The health situation is worse now and affects people in developing as well as industrialized countries.  Let’s hope the General Assembly puts health above politics this time.

My monthly (first-Sunday) Food Matters column in the San Francisco Chronicle continues the conversation about use of food stamps to buy sodas.

Food stamps should not be valid for soda purchases

Q: When I see people in grocery stores using food stamp benefits to buy sodas, I get upset. Why does the government allow this?

A: My quick answer is lobbying, but discomfort about whether welfare benefits should permit the poor to eat as badly as those who are better off dates back to the English Poor Laws of the 16th century.

New York City’s proposed pilot project banning the use of food stamps for buying sugary sodas is only the latest event in this long and complicated history.

Welfare policies have always been designed to give the poor just enough to keep them off the streets, but not enough to induce dependency. The tension between these goals has resulted in scanty benefits – and endless debates.

Today, the debit cards provided by SNAP (Supplemental Nutrition Assistance Program) can be used for all foods with these exceptions: alcoholic beverages, pet foods, nutrient supplements and on-site prepared foods.

New York’s proposal to add sodas to the “can’t buy” list is based on evidence linking sugary sodas to obesity, their lack of nutritional value, and estimates that SNAP recipients spend $75 million to $135 million in city benefits each year.

The proposed ban does not stop SNAP recipients from buying sodas. They just won’t be able to use SNAP benefits for them.

Soda companies strongly oppose this idea, of course, but so do many advocates for the poor. Advocates argue that the restrictions are insensitive and condescending in assuming that the poor are uniquely unable to make sensible dietary decisions.

The real problem, they correctly point out, is that low-income Americans – with or without SNAP benefits – cannot afford to buy healthy foods or do not have access to them.

As a result of such arguments, I have long been uncomfortable with the idea of the soda ban. But in recent months, I have come to support it. Here’s why:

Evidence is strong that sugary drinks predispose to obesity, and obesity rates are higher among low-income households. In New York City, for example, obesity and Type 2 diabetes are twice as prevalent among the poorest households compared with the wealthiest. Preliminary evidence suggests that sugars in liquid form may especially predispose to obesity.

Overall, soda companies have worked hard to create an environment in which drinking sugary beverages all day is normal. They lobby to introduce and retain vending machines in schools. As sales in the United States have declined, they increasingly market their products to people in developing countries.

They put millions of dollars to work fighting soda taxes and, no doubt, the proposed SNAP ban.

I’m impressed by the comparison of the SNAP approach, which allows benefits to be used for most foods, to that of the WIC (Women, Infants and Children) program. The USDA runs both programs. WIC, the most demonstrably nutritionally successful of all food assistance programs, allows benefits to be used only for a restricted number of nutrient-rich foods.

In 2010, SNAP benefits went to more than 40 million people at a total cost of more than $68 billion. We need to focus on finding ways to make healthful foods more affordable and accessible to low-income families – doubling the value of SNAP benefits when used for fruits and vegetables, for example, or promoting incentives to move grocery stores, and community gardens into inner-city areas.

Still, soft drink companies have had a free ride for decades.

I hope the USDA will approve New York’s proposed ban.

This morning I received an e-mail query from Jan Poppendieck, author of three truly outstanding books that I often use in classes:

• Breadlines Knee Deep in Wheat: Food Assistance in the Great Depression
• Sweet Charity Emergency Food and the End of Entitlement
• Free for All: Fixing School Food in America

Q.  I am collecting opinions on the proposal to ban use of SNAP (food stamp) funds for buying sodas.  What do you think of that idea?

A.  I started out deeply uncomfortable with the idea of the soda ban but I now support it.   The discomfort came from my general discomfort with telling people what I think they should be eating. I never comment on what individuals eat (and I hope you won’t comment on what I eat). My work deals with nutrition for populations, not necessarily individuals. So banning sodas at first seemed to me to be too personal an approach.

But I changed my mind for several reasons:

• The increasingly strong evidence that sugary drinks predispose to obesity
• The disproportionately higher rates of obesity among the poor
• The suggestive evidence that sugars in liquid form are especially predisposing to obesity
• The comparison of the SNAP approach (the benefits can be used for most any food) with that of WIC (the benefits only work for a restricted number of foods)
• The focus of soda companies on marketing to children and youth in low-income areas
• The lack of grocery stores in low-income areas
• The intense marketing of sodas to children and youth in developing countries
• The increasingly successful efforts of soda companies to co-opt health professional groups with partnerships, alliances, and grants
• The astonishing amount of money and effort used by beverage companies and associations to fight soda taxes and, no doubt, this idea as well

Soft drink companies have gotten a free ride for years.  They moved into schools and created an environment that makes it socially acceptable for children to drink sodas all day long.  If sodas are now under scrutiny for their role in obesity, it is because soda companies are reaping what they have sown.

Michael Siegel, MD, MPH, a Professor at the Boston University School of Public Health (whom I do not know), has been mailing me copies of his recent blog posts on partnerships between food corporations and health organizations, particularly the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) (see my previous posts), and the American Dietetic Association (ADA) (see my previous posts on this one too).

Dr. Siegel’s current post discusses two reasons why these partnerships do more for the food companies than they do for the organizations:

1. Coca-Cola and other Big Food companies are using these partnerships to enhance their corporate image, and therefore, their bottom line: sales of unhealthy products that are contributing towards the nation’s obesity epidemic.

In its 2010 annual report, Coca-Cola writes: “…researchers, health advocates and dietary guidelines are encouraging consumers to reduce consumption of sugar-sweetened beverages, including those sweetened with HFCS or other nutritive sweeteners. Increasing public concern about these issues…may reduce demand for our beverages, which could affect our profitability.”

…Pepsico, in its 2010 annual report, also makes clear the connection between the company’s public image and its bottom line: “Damage to our reputation or loss of consumer confidence in our products for any of these or other reasons could result in decreased demand for our products and could have a material adverse effect on our business, financial condition and results of operations, as well as require additional resources to rebuild our reputation.”

2. The American Dietetic Association, American Academy of Pediatrics, and American Academy of Family Physicians are supporting companies that oppose virtually every state-specific public health policy related to improvement of school nutrition, reduction of junk food and soda consumption, and environmental health and safety.

…Through its contributions to the Grocers Manufacturers Association (GMA), Coca-Cola is opposing any and all taxes on sugar-sweetened beverages (soft drinks), opposing the removal of BPA from bottles containing liquids consumed by infants, opposing legislation to simply require the disclosure of product ingredients, opposing taxes on candy, opposing bottle bills, opposing all restrictions on BPA-containing packaging, opposing standards for food processing, and opposing school nutrition standards.

…That the AAP, AAFP, and ADA have fallen for Coca-Cola’s tricks is one possibility. The other, which I find more likely, is that they have been bought off. In other words, that the receipt of large amounts of money has caused them to look the other way. It’s amazing what a little financial support will do. And of course, this is precisely the reason why companies like Coca-Cola and Pepsico include the sponsorship of public health organizations in their marketing plans.

I’m just back from the American Society of Nutrition meetings in Washington, DC, where the daily newsletter put out by the society included full-page advertisements from Coca-Cola, the beef industry, and the Corn Refiners Association (see yesterday’s post).  And then there is the astonishing example of Coca-Cola’s $10 million gift to Children’s Hospital of Philadelphia to head off a potential city soda tax.

It is completely understandable why food and beverage companies would want to buy silence from health professionals.  It is much less understandable why health organizations would risk their credibility to accept such funding.  Professor Siegel’s analyses of these issues are worth close attention.

As a commentary on my recent post on soft drink marketing, Jerry Gross Yisroel sends this photo, which he took a week or so ago in front of the emergency entrance to Beth Israel Medical Center, Brooklyn.

They do say that a picture is worth a thousand words….