Two weeks ago, New York Mayor Michael Bloomberg proposed a ban on the largest sizes (over 16 oz) of sugary drinks at restaurants, movie theaters, and arenas. The beverage industry was poised with messaging and has largely owned the conversation across the political spectrum. Rather than engage or repeat their messaging, thus giving their talking points more airtime, let’s pay attention instead to the ban behind the curtain.
NYC’s proposal takes a smart and fair approach. The proposed ban restricts the actions of corporations –– albeit imperfectly, but functionally –– while enabling consumers to buy more if they want more but stop drinking if they don’t. This puts the blame squarely on industries where it belongs, although it’s only one piece of what needs to be done about sugary drinks and public health.
Why does size matter? In short, it’s irresponsible to sell something at a size or concentration that passes a certain threshold of safety. There’s a concept in environmental health and medicine called the dose-response relationship. It’s pretty simple: At different doses, a substance will affect a human being (or other organism) in different ways or to a different extent. A 200 mg pill of ibuprofen is safe. A 200 gram pill of ibuprofen… not so much. You will not find Advil Grande or Advil Venti anytime soon.
Unlike medicine, soda isn’t good for you even in a small dose, although the health consequences of a large dose aren’t so quick and dramatic as those of a giant pill. But those health consequences are real, and they’re made worse with repeated exposure. So while small sodas are also terrible for you, a size ban sends the message that it’s irresponsible to market and sell large sodas, particularly when drinking large sodas begets drinking more large sodas. But does it?
Portion size can influence human behavior, and in the case of soda, it can do so in two ways, one short-term and one long-term:
In the short term, people are more likely to finish whatever food is in front of them, determined by, among others, this study, in which one group ate more out of secretly-refilling soup bowls than a control group ate out of regular bowls. (Side note: I secretly want one of those soup bowls, but for actual soup.)
In the long term, high doses of liquid fructose impair hormones that regulate weight, appetite, and fullness, leading people to consume more and get sick. Sodas and other forms of highly-marketed liquid fructose are dangerous, period. But they’re especially dangerous in quantity and with repeated exposure. High doses of fructose over time change hormones, brain signals, and metabolism so that we want more soda and food. Add to that the evidence that intense sweetness is more addictive than cocaine.
This kind of information complicates the much-loved trope that dietary choice is all about individual choice and behavior. Does a consumer really have control if he or she is buying and consuming a product that impairs the body’s own built-in mechanisms for control? “Appetite control” starts to take on a more insidious meaning when the product itself changes our appetite.
Liquid carbohydrates are bad news. They don’t trigger fullness the way solid ones do, so sugary drink calories may add to rather than supplant meal calories. Sugary drinks are overwhelmingly correlated with obesity and diabetes risk, among many other diseases. Fructose intake is connected with insulin resistance and metabolic syndrome. The dose-response relationship between soda and measures of health is especially bad in children, who are smaller than adults and going through critical stages of development; a single increase in serving size per day raises a chid’s obesity risk 60%. The beverage industry disproportionately targets marketing to children and communities of color. There is much more to know about soda and health. Search online for more information about sugary drinks and high blood pressure, gout, lower nutrient intake, lower bone density, hypertension, and other health problems.
It’s dangerous stuff. I’d rather sugary drinks weren’t made with fructose or synthetic sweeteners, that there were limits on sugar/sweetener concentration in beverages, and that sugary drinks weren’t sold at all in public or tax-payer-funded places or places that draw children. Bloomberg’s message is a strong one, and a starting place. He uses visual images of large cups to call out the sizes that are the most unhealthy, and shame companies for pushing those sizes.
No starting place is perfect. But perhaps exposure in fast food restaurants may naturally lead to changing norms for soda intake at home too, where childhood sugary drink consumption is an even larger problem, and a much harder one to fix. That’s why a plan like Bloomberg’s has to operate alongside other ways to restrict corporate behavior, get allies across different fields and industries, and inform and empower the public. Communities across the country are strategizing about this issue, although unfortunately it looks like many resources have to go to countering the dollars spent by the beverage industry.
By the way, the largest size soda that would be allowed under this ban, 16 oz, currently costs just $1.19 at a McDonald’s in Manhattan. I’m guessing that barely covers Manhattan rent on the space it takes up for the time before it’s finished and tossed. It’s pretty cheap. In the end, though, I’m guessing many consumers won’t get up and buy a second soda or take a refill, because they won’t want a second soda.
Win for the consumer, loss for the industry. Until it figures out how to make a 16 oz secretly-refilling cup.
Image source: http://www.roadsideamerica.com/tip/19684