• It’s the policy that I doubt, not the beverages

    More than one of you sent me the following study at the end of last week. “Caloric effect of a 16-ounce (473-mL) portion-size cap on sugar-sweetened beverages served in restaurants“:

    Background: New York City recently proposed a restriction to cap the portion size of all sugar-sweetened beverages (SSBs) sold in food-service establishments at 16 oz (473 mL). One critical question is whether such a policy may disproportionally affect low-income or overweight individuals.

    Objective: The objective was to determine the demographic characteristics of US individuals potentially affected by a 16-oz portion-size cap on SSBs and the potential effect on caloric intake.

    Design: We analyzed dietary records from the NHANES 2007–2010. We estimated the proportion of individuals who consumed at least one SSB >16 fluid oz (473 mL) in restaurants by age, household income, and weight status.

    Results: Of all SSBs >16 oz (473 mL) purchased from food-service establishments, 64.7% were purchased from fast food restaurants, 28.2% from other restaurants, and 4.6% from sports, recreation, and entertainment facilities. On a given day, the policy would affect 7.2% of children and 7.6% of adults. Overweight individuals are more likely to consume these beverages, whereas there was no significant difference between income groups. If 80% of affected consumers choose a 16-oz (473-mL) beverage, the policy would result in a change of −57.6 kcal in each affected consumer aged 2–19 y (95% CI: −65.0, −50.1) and −62.6 kcal in those aged ≥20 y (95% CI: −67.9, −57.4).

    Conclusion: A policy to cap portion size is likely to result in a modest reduction in excess calories from SSBs, especially among young adults and children who are overweight.

    This was a retrospective study comparing those who drank at least one 16 oz or greater sugar sweetened beverage per day to those who did not. The results aren’t surprising. Most of the beverages were purchased from fast food restaurants. And, more than 7% of adults and children partook of at least one such beverage each day. Moreover, the study found that if a policy banning such beverages were enacted, and people decided to abandon these large beverages, they’d consume about 60 less calories per day.

    I don’t doubt any of this. But it all misses the point. I’m concerned that the policy won’t result in what the researchers hope will happen. In fact, simulations show things could get worse. There’s lots of evidence that it’s more than just the sugar sweetened beverages that’s the problem. Plus, this:

    How does it make sense to ban a 225-calorie soda when a “Gotta Have It”–sized PB&C (peanut butter and chocolate ice cream) shake at Cold Stone Creamery clocks in at 2010 calories alone? That drink got the top prize in the 2011 Xtreme Eating Awards sponsored by the Center for Science in the Public Interest. Or perhaps you could wander over to the Cheesecake Factory and get yourself a Farmhouse Cheeseburger (for 1530 calories) and a nice piece of Ultimate Red Velvet Cake Cheesecake (for an additional 1540 calories). Without even touching a French fry, you’ve consumed more than 3000 calories.

    Fancier food isn’t immune either. A Morton’s steakhouse Porterhouse with mashed potatoes and half a side of creamed spinach rates 2570 calories, 85 g of saturated fat, and 2980 mg of sodium. As the CSPI noted, “That’s the calories of eight pieces of Original Recipe chicken plus mashed potatoes and gravy, coleslaw, and four biscuits at KFC [Kentucky Fried Chicken], with an extra 1½ days’ [saturated] fat on the side.”

    I’m sorry, but banning the soda and leaving the rest untouched is silly to me. It’s a distraction. I’m all for trying to get people to reduce their caloric intake. I don’t think another study showing us that some of those calories come from sugar sweetened beverages convinces me that a ban on this one thing is worthwhile.

    @aaronecarroll

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    • I’m still on the fence on this particular debate (not sure how I’d vote if it were up to me), but one argument that the ban could be worthwhile is if it’s viewed more as a research tool or a stepping stone than as a final policy position.

      Politically, comprehensive caloric policy is probably impossible to implement. Americans like to eat 2000 calorie steaks, at least now and again. Even the very narrow cola ban is likely to fail at a time when obesity and diabetes are rising and the irons of public perception may be hot for striking somewhere. But given the choices, the possibility of passing some legislation reasonably could be better than not trying at all, or trying to pass something that would never pass.

      I’ve seen a lot of this style of argument politically, and I wonder (as an outsider to political and economical analysis), if there’s a name for it. Specifically I mean arguing against a policy that heads in a certain direction because it doesn’t go far enough. It’s a form of false-dichotomy, I think, between a perfect (but non-existent) policy, and the proposal at hand.

      Admittedly, your article points out that it “could get worse”, but since you’re directly replying to an article that estimates a 60 calorie daily reduction that you claim not to doubt, I felt the article fell into this category of admitting the problem but appearing against the only attempt — possibly the first step — at a solution.

      The question of whether the ban is worthwhile is not solely what the results of this and only this change will be… it must additionally include broader analysis of how this proposal will test the waters for future policy: Will this ban stand up against legal challenges the way tobacco laws have? Will it withstand political pressure from soda consumers? Will it provide better research fodder than the simulations and guesstimations currently discussed? Will it open the door for more comprehensive policy down the road? Or Will it backfire and close the door permanently on more comprehensive policy effectively making things worse?

      • You misunderstand me. The 60-calorie reduction is what would happen if people dropped the SSB. What is in doubt is whether the 16-oz ban would result in that behavior change.

        I’m sorry, but I’d like to see research first before large-scale policy goes into effect.

      • Perhaps the confusion here is over the nature of the ban Bloomberg proposed. He didn’t ban people from drinking more than 16-ounces of SSB. Instead, he banned containers capable of containing more than 16-ounces of SSB. There are lots of really, really easy ways around this regulation. For one thing, most of the establishments to which it applies, including all fast food places I’ve ever been to, offer free refills on all beverages. And for carry-out customers ineligible for free refills, they can simply include two 16-ounce drinks as part of a large size meal. And even barring that, people always have the option of buying more than one drink.

        Bloomberg’s hypothesis was that the “ban”–which doesn’t really ban anything–would work anyway because people get large soda’s not because they want that much to drink, but because they are unaware how much volume fits in a large-size drink. We now have research showing that Bloomberg was wrong–people really do want that much soda. And the article Aaron linked to shows that, whether due to bundling effects or framing effects, the banning larger sizes can actually lead to an increase in consumption.

        Also, from a normative economic perspective, I think there’s an extent to which people’s revealed preferences need to be respected by policy makers. One possibility is that there is some market failure such that people aren’t aware that SSB is making them obese. Another possibility is that people actually are better off being obese and enjoying SSB than they would be as skinny people deprived of their favorite kind of consumption.

    • Being against the law on your grounds it would appear is a case of great getting in the way of good as our medical director is fond of saying. Yes, you could get a shake at Cold Stone, or a stake at Morton’s, but the overall majority of people don’t eat at those places every day or even monthly. The most of the consumption occurs at “fast food” restaurants, which would have been the target of the ban. While likely not having a great effect, it could have been an important first step in fighting the obesity epidemic IMO.

    • “I’m sorry, but banning the soda and leaving the rest untouched is silly to me.”

      Aaron, I understand your logic with regard to the 16 ounce coke with so many things that are just as bad or worse. What I wasn’t sure of was if you were willing to ban a whole group of foods that have excessive calories. I don’t think you believe government should use coercive methods to control people’s diets. Do you? I am not talking about risk adjustments by insurer’s.

      • I don’t think bans work, period. There are other ways to do this…

      • We could always impose a tax on unhealthy foods. Since the tax receipts can be used to offset other, more distortionary kinds of taxes (income taxes, for example), we could potentially eek out a net gain even if we are wrong about the welfare implications of unhealthy foods.

    • Not sure where I stand on this issue, but definitely not for bans. If anything, how about a Pigouvian tax on calories (or sodium or sugar, etc.) past a certain amount at restaurants? Would be harder to implement though…