We’re getting to the point where I’ve written more on this one small piece of public policy than any other. So be it. It’s fascinating. In this week’s NEJM, the debate on the soda ban continues:
From the glass-half-empty perspective, the policy is a drop in the bucket of what would be required to solve the obesity problem. Setting limits on just a single behavior, in the face of all the other unhealthy choices we must avoid (fried foods, excessive portions, carbohydrates galore), can hardly be expected to turn the obesity tide. Moreover, because the ban contains all kinds of loopholes — it doesn’t set limits on refills, for instance, and it excludes (“on suspect grounds”) “other beverages that have significantly higher concentrations of sugar sweeteners and/or calories” — the charge that it is “arbitrary and capricious” may strike opponents as more descriptive than acerbic.
But from the glass-half-full point of view, the ban is not about attacking individual choice but rather about limiting corporate damage. If we see supersized drinks not in terms of the individual’s freedom to be foolish but instead as a kind of industrial pollution that is super-concentrated in impoverished neighborhoods, limits on drink size become a far different kind of regulatory measure. The target is not the individual: it is the beverage industry, corporate America. To be sure, the ban does not take on every industrial enterprise that is bent on profiting from inundating Americans with cheap, empty calories. But it does set what may be taken as a new precedent — though it’s also a move with deep historical roots.
My issue has always been that it’s not comprehensive or holistic. Large sodas are not the only problem with obesity. You can still drink lots of small sodas. Moreover, you can still get super-sized means, monster desserts, and huge shakes. And beer. You can even get large sodas in plenty of venues. All of this made the ban feel more theatrical than purposeful. If we’re going to start restricting people’s behavior, we have to have a better reason.
The whole piece is worth a quick read. Especially the conclusion:
A ban on containers larger than a certain size does not alter our capacity to drink as much sugary beverage as our bodies can tolerate — indeed, in a context of constant exposure, more than either our bodies or underserved communities can withstand. As with tobacco, it would take a tax on sugary beverages to effectively limit our individual ability to drink ourselves silly. But that is not what the currently contested proposal seeks to do. The aim of a ban on oversized sodas is to reduce the level of sugar and calorie assault that any single beverage dose represents. The assumption, of course, is that people won’t simply buy more and that intake will be reduced. But the target is corporate behavior.
A cap on beverage size would leave us with a soda cup half empty, but it opens an avenue to changing corporate practice. The New York City ban is limited to businesses that the city itself can regulate without causing undue hardship; addressing inconsistencies such as limiting the size of some drinks in establishments that receive inspection grades from the city health department while leaving others free to brim over would require similar regulatory action on the part of New York State. But if Bloomberg is bent on appealing Tingling’s ruling, it is time to start making a case with some muscle, which will require strong, active support from the medical and public health communities. If we can challenge the industries and businesses that profit by promoting bloated serving sizes, perhaps we can take on other corporate enterprises that similarly contaminate our social environment.
I can get behind comprehensive action more than I can window-dressing.