• Prohibition won’t work for soft drinks any more than it did for alcohol

    A number of you have asked me what I think about Mayor Bloomberg’s policy to ban soft drinks larger than 16 ounces. My answer can be found today on a post at the JAMA Forum. Go read it!

    @aaronecarroll

    Share
    Comments closed
     
    • My response to your post would be this.

      The soft drink lobby has immense power. They’ve killed every soda tax that’s been proposed. They’ll do anything and everything short of armed insurrection to keep the status quo.

      I’ll grant that they’ve done voluntary initiatives much more than the tobacco industry in its day, but those aren’t going to change anything either.

      Obesity is such a multifaceted problem that I think that any solution is going to have to involve some level of intrusiveness. This law gets us a toehold. Remember, all soda taxes (which I’d argue Americans now think is intrusive) have been shot down. When you have a semi-ban on soda, obviously some people will act as if they’re shepherding soda drinkers to concentration camps, but over time, people will habituate to this. And then we can raise the intrusiveness level if we find that’s justified.

      I realize that I sound like a conservative caricature. However, like I said, we all agree obesity is a huge threat. Voluntary measures alone by individuals and the food industry will not cut it. Some level of intrusion into people’s liberty will be necessary. Ethically, intrusion should only be justified if it’s to combat a significant threat, and if the intervention is well targeted. I agree that we meet the first condition and not the second.

      However, the soda industry successfully opposed soda taxes that were less intrusive and better targeted (although still not perfect). They got what they deserved. And this will pave the way for a soda tax. Someone’s got to intervene first. If it does, then the intrusion was justifiable. But like it or not our society evolves in fits and starts, and we don’t even know how to create a widespread, holistic intervention on obesity.

      • Oh, I was born in Singapore. Here’s how we do it.

        If you’re overweight in K-12, you get marched to extra fitness classes.

        If you’re a male and you’re overweight upon mandatory enlistment into military service, you get marched to extra fitness classes. Literally marched. And trust me, exercises in the army are intense of necessity. If you get below a certain grade on the mandatory annual fitness tests administered to anyone above about 4th grade, you have to serve 2 months longer than if you passed (this was true as of 10 years ago at any rate).

        Now, THAT’s intrusive.

        Or we could do like Cleveland Clinic, which banned smoking, then banned smokers, then made its employees do fitness classes (and if you don’t your premiums are higher). Less intrusive, but it has reportedly worked (either that or it’s increased health solely through a selection effect).

        Either way, I think there will be no serious reduction in obesity on a societal level without some level of intrusiveness. Dr. Carroll lost quite a lot of weight on his own, but the point is that we have to replicate that weight loss among people who have less access to or ability to make/procure good food, who may have less time to exercise (e.g. irregular schedules), who may be less motivated, who may have lower health literacy, etc.

    • I don’t understand why you’re comparing the soda “ban” to Prohibition, when it makes way more sense to compare it to how we treat cigarettes. As you write: “We still haven’t tried to make cigarettes illegal. We may make it difficult to smoke, and we may make it expensive, but it’s still legal, and you can still do it.” That’s EXACTLY what this ban does with soda– it doesn’t make it illegal to consume more than 16 ounces of soda, it just makes it more difficult and likely more expensive.

    • In response to your “large” vs two “small” cigarette analogy…
      Kind of anecdotal:
      When I was in high-school I worked at a Cold Stone, and whenever a customer would order a “like-it” (small, 5oz i think) size we were told to cheerfully inform them that for 40cents more they could get almost double the ice-cream! (love-it, medium size, about 8oz).
      This mechanism worked more often than not. (Actually, if you want to know something really insidious, they would track our sales to see your ratio of medium to small cups sold, and those with the highest ratios would get bonuses….)
      Anyways, I think the point is that the economics of larger sized portions at many places makes it so two 12oz drinks does not equal a 24oz drink. (at least not in terms of cost…) In fact, I think most places (like my Cold-Stone) charge only a marginal fee for serious portion increases.

      Otherwise thought the article was spot on, (too small a step, and one that will piss a lot of people off…) though maybe in 20 years we’ll look at 5 boroughs life-expectancy data and wonder about what forward thinking public-health policies have pushed the expectancy’s up so rapidly!

    • I don’t see why it would work.

    • I agree with LT. Two 12oz drinks are not equal to one 24oz drink. Also, I can’t stand it when people say “________ policy/intervention isn’t going to solve the obesity problem.” Guess what! There is no single policy/intervention that will solve any major problem we face, be it the debt crisis, the obesity epidemic, global warming, poverty, or health care reform, just like there is no single pill you can take or food you can avoid to magically become healthy. Solutions to major problems require concerted action from many different angles. No, the soda ‘ban’ is not going to solve the obesity problem, but it’s a step in the right direction.

    • I posted this elsewhere but I think that it is appropriate here:
      Yesterday, I heard on the radio a discussion featuring the authors of the book “Zoobiquity” (http://zoobiquity.com/book). They made a strong case that it is simply abundance that makes us obese. They pointed out that our pets have gotten fat along with us and that animals in the wild get fat in times of abundance.

      So, I do not think that particular foods and drinks are the problem but simply the abundance of food and implies that if you are to have an effective tax it would have to be a calorie tax, that taxes all consumable calories equally.

      Also, I do not like the phrase “empty calories”, it is the amount of calories regardless of whether they are empty or full. If I drink a big gulp with vitamins in it I will get just as many calories and gain just as much weight.