The NYC Board of Health’s first act in 1866 prohibited hogs and goats from “running at large in our city,” a ban that helped slash cholera deaths by 90 percent. Will the board’s latest act — banning large servings of sugary drinks – have a similar transformative effect on health? Deepu Gowda, MD, MPH — Columbia internist, and member of the Board – talks about the ban and his vote.
1. The “soda ban” passed the Board of Health with a vote of 8-0, with one abstention. Why did you vote for the ban?
This resolution has been unfortunately mischaracterized as a “soda ban”. There is no ban on soda. People can still choose to drink as much soda as they want.
Rather, this is a targeted effort to regulate harmful food industry marketing practices. Soda sizes have not grown as a response to consumer demand but rather industry business strategies. There is evidence that sugary drinks and large portion sizes are a major driver in increases in calorie consumption. Currently, over half of New Yorkers and 40 percent of New York City’s school kids are overweight or obese. A study published in the New England Journal of Medicine in 2005 predicted that if current rates of obesity in kids continue to rise unchecked, this generation of children may be the first in two centuries to have a lifespan shorter than their parents.
We have become acclimatized to the prevalence of obesity and diabetes in our society, just as we have become accustomed to mega-sized drinks. But the obesity epidemic is a real crisis with real consequences. It is our responsibility to take action on a larger level to affect this trend of obesity.
2. You’ve been an internist for 10 years in Harlem and Washington Heights. How did that experience influence your decision?
During my work in Harlem and Washington Heights, I have been awestruck by the burden of illness tied to obesity and diabetes. So many of my patients have suffered heart attacks, strokes, blindness and loss of kidney function as a consequence of these conditions. Many others live while tethered to injections and pills. And sadly, families lose their loved ones prematurely because of these conditions.
Yet, all you have to do is step out of the hospital and walk around to understand the forces at play. It’s easy to buy a 20 or 32 oz soda with hundreds of calories and no nutritive content, but try to find affordable fruits and vegetables. You may have to do some hunting. We are indeed “nudged” by our environments in the direction of calorie-dense and nutrient-poor foods and drinks. Things are changing and the City has developed great programs to bring fresh produce to these resource-poor neighborhoods. But we have a lot more work to do if we want a healthier future for New Yorkers.
3. Some critics of the ban contend that there’s little science backing up the idea that sugary drinks contribute to obesity, or that restricting them will reduce obesity.
This is an important question. The evidence is convincing that container size affects caloric intake for a variety of foods. People tend to drink the amount that is presented to them. Give someone a larger cup and they will drink more and take in more calories. This has been shown in randomized experimental settings where subjects took in 50 percent more sugary beverage when given a larger cup. In addition, these same studies have shown the body doesn’t seem to become satiated from calories in sugary drinks the same way as it does with calories in foods. So people simply add on the calories consumed in drinks instead of replacing other calories they would have consumed in foods.
Large cohort studies and experimental studies have shown a link between sugary drink consumption and weight gain in adults and children. And importantly, there also have been several trials showing that groups randomized to reduce sugary drink consumption had resultant weight loss.
What we don’t have are large-scale studies showing that this kind of policy change will have an impact on obesity or incidence of diabetes, because such a policy has never been implemented. My feeling is that waiting for perfect evidence is not the right approach when we are dealing with health concerns of such proportion. The DOH will be very interested in tracking purchase and consumption behaviors as well as health outcomes after policy implementation.
4. Some media reports suggested that the board’s vote was just a rubber stamp of an initiative from City Hall and the mayor.
The Board of Health is an independent panel of doctors and public health experts who have an obligation to serve the health of citizens of New York City. Board members are not employed by the City nor are they beholden to views of the Health Commissioner or to the Mayor.
The Board rigorously considers the scientific basis for any proposal that is brought before the body and its actions are definitely not a rubberstamp. I have found that the members of the Board consider the issues with rigor and in earnest and wish to contribute from their area of expertise.
The harmful effect of sugary drinks and portion size has been a national public health concern. Even though Mayor Bloomberg is interested in this issue and remains a staunch advocate for public health, this is a New York City Department of Health initiative. The proposal was developed and presented by the DOH and then considered by the independent panel, the Board of Health.
5. What kind of effect do you think the ban will have on the health of New Yorkers?
Expecting any one policy change to dramatically shift obesity or diabetes incidence in the city would be misguided. The factors that have produced the obesity epidemic are numerous and complex, and they include the fact that we’re not expending the same amount of energy that we used to. The beverage size resolution is only one step towards creating healthier environments for New Yorkers.
My hope is that this type of change will in fact reduce sugary drink consumption and facilitate weight loss for adults and children in New York. The dialogue that has been generated is also immensely valuable. This heightened awareness of the caloric and nutritive value of the foods and drinks we are consuming will hopefully also help us make healthier choices.
Restaurants and the food industry will also hopefully recognize the responsibility they have to their customers and will seek ways to meet commercial interests while providing healthier options. As we know, food has the power to heal as well as harm, and wouldn’t it be great if commercial interests were aligned with its healing power? I feel that public health and commercial interests need not be in opposition and we need to continue to seek incentives for better alignment.
This is a small step in the direction of broader cultural and environmental changes that need to take place in order to bend the obesity curve. Lastly, I would say that I am proud to be a citizen of a city that has been so forward thinking and bold in advocating for the health of its members.