Evidence-Based Diabetes Management

Will NYC’s New Mayor Follow Through on Soda Limits?

Published Online: December 14, 2013
Peter Page
Little overlaps in the world views of New York City’s outgoing and incoming mayors, but on this they agree: The Big Apple would be better off without the Big Gulp.

Mayor Michael Bloomberg, who leaves office December 31, 2013, was as zealous about pushing New Yorkers to quit smoking and lose weight as he was about stop-and-frisk policing. In his third term, he pressed the city’s Board of Health to make New York City the only place on the planet to cap sugar-sweetened beverages at servings of no more than 16 ounces, defined as containing more than 25 calories of sugar in 8 ounces.1

Though pilloried by critics and parodied on late-night TV, Bloomberg’s so-called “soda ban” is supported by a growing body of evidence that sugarsweetened beverages, or SSBs, not only contribute to childhood obesity but also to cardiovascular disease. In March 2013, a lower court ruling reversed the portion cap based on questions about the Board of Health’s authority and uneven enforcement—for starters, New York State regulates 7-Eleven, so the “Big Gulp” would remain. But so far no court has questioned the scientific foundation of whether a portion cap was good for public health.2

Perhaps for that reason, on October 17, 2013, Bloomberg vowed to move on to the New York State Court of Appeals, stating, “I’ve got to defend my children and yours, and do what’s right to save lives. Obesity kills. There’s no question it kills.”2

Sugar-sweetened beverages, typically soda, are sold in “large” portions that start at 20 ounces and range up to 64 ounces. A coalition of small retailers, labor unions and the state’s beverage industry sued, successfully claiming the Board of Health overstepped its authority when it passed the Sugary Drinks Portion Cap Rule. The Court of Appeals announced it will take up the case early next year, after Bloomberg’s successor, Mayor-elect Bill de Blasio, takes office.

De Blasio’s position on the portion ban has taken an interesting route. As the city’s public advocate and later as a mayoral candidate, he found his political base in neighborhoods where police stop and frisk the most but also where sales of sugary drinks are brisk and rates of obesity and diabetes are highest.

The “soda ban’’ was not popular with the de Blasio base, but he praised Bloomberg and gave a full-throated endorsement of the cap when asked during the campaign.3

“I’m not ever afraid to disagree with Mayor Bloomberg when I think he’s wrong, but when I think he’s right, my job as public advocate has been to support policies that have been good for the people; and I think as a parent, especially I feel we have been losing the war against obesity,” he said.3

“We have to, of course, look at the specifics with our own lawyers to handle the mechanics, but there’s no question I want to see this rule go through,” de Blasio continued. Published reports, however, hint that de Blasio may take a different path to achieve the same public health goal; his transition team did not return multiple calls and e-mails from Evidence-Based Diabetes Management.

De Blasio’s support for the portion cap rule was not the first time he worked with Bloomberg on an obesity initiative. In 2010, as public advocate, he supported Bloomberg’s effort to gain US Department of Agriculture approval of a trial program to remove SSBs from the list of foods approved for purchase with food stamps, essentially categorizing the drinks with cigarettes and alcohol.4

The petition was the target of intense lobbying by Bloomberg and the beverage industry. De Blasio was one of the first elected officials to support the controversial proposal, which was opposed by some of his political supporters. The Department of Agriculture rejected the pilot program in 2011, arguing it was “too large and complex.’’5

“By subsidizing the purchase of soda with food stamps, we’ve been unwittingly stacking the deck in favor of these unhealthy beverages,” de Blasio was quoted saying at the time. “This pilot program could help even the odds for healthier foods.”

The Case Against Sugary Drinks

De Blasio’s policy instincts align with a swelling body of research that cheap, jumbo-sized sugar-sweetened beverages are more responsible for the global obesity epidemic than any other factor.6 The American Heart Association (AHA), in a 2009 scientific statement, linked the “pandemic of obesity and cardiovascular disease’’ to a parallel increase in sugar consumption, calling sugar-sweetened beverages “the primary source of added sugars in Americans’ diets.”

The AHA found that from 1970 to 2005 US per capita sugar consumption increased 19%, adding 76 calories per day with calories from sugar totaling 355. It recommended drastically reducing sugar consumption to “a prudent upper limit’’ of 100 calories per day for women and 150 for men.7

The case against consuming too much sugar has mounted since the AHA statement. Research published in 2010 in the Journal of the American Medical Association reported “a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.’’ Nonalcoholic fatty liver disease (NAFLD) prevalence has more than doubled over the past 20 years and currently affects nearly 11% of adolescents and one-half of obese males.8

Adolescents who increase sugar consumption increase their cardiovascular disease risk,9 while a study of 224 overweight and obese adolescents children aged 2 through 17 years found substituting water for all SSBs trimmed 235 calories per day and concluded that their average daily consumption of 1.7 servings of sugar-sweetened beverages “may cause excessive weight gain.”10 Adolescents from that study group who participated in an intervention that reduced their consumption of SSBs to 0 over a year achieved “significant’’ weight reduction compared with a control group.10

Research published in 2009 and 2011 by Kimber Stanhope, PhD, RD, of the Department of Molecular Biosciences at the University of California, Davis, and her colleagues demonstrated that routine consumption of fructose-sweetened drinks by older, overweight adults soon caused increased weight gain around the middle, and worsened cardiovascular risk factors and the ability to utilize insulin properly.

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