Human Limits

Last week the New York City Board of Health restricted the sale of sodas larger than 16 ounces in restaurants.  The rationale for the ban is pretty straight forward and based on the ideas I have reviewed in recent posts on the “extra” calories people in the U.S. have been eating over the last 30-40 years.   Since many of the calories are coming from soft drinks, and because soft drink portion sizes have been rising, the idea is to limit portion size.    Here is a link to an article on the action of the board and some of the likely fall out.    That having been said, in this post I do not want to take a deep dive into the specifics of the NYC ban, but want to look at some larger issues about “regulating” behavior and its impact on health.  Here are a few questions to think about.

 

1)    Will the large drink ban “work” and lower obesity rates?  The short answer is that no one knows but perhaps clues are available from studies on what happens to obesity in schools that ban soda and other sugary drinks.   One of the problems is that if just soda is targeted people will just drink other sugary drinks or more soda other places.  At least some evidence from the schools support these ideas and suggest the ban itself might not do much for NYC as a whole.   However, there is also evidence to support the idea that limiting access to sugary beverages in schools works if it is part of a comprehensive and what might be called “common sense” approach.

 

“Children who attended schools where soda pop and non-low-fat salty snacks could be purchased were more likely to be obese than those at schools where such items were not sold. Children whose parents rarely or never ensured that their child was avoiding eating too many sweets, avoiding spending too much time watching TV, or engaging in physical activity were more likely to be obese than children whose parents did so always or most of the time.”

 

2)    Can healthy choices be “legislated’?   If we think about how much smoking has declined over the last 30-40 years (see the figure below) it is pretty clear that healthy choices can be legislated.

 

 

The same can be said for the improvements in traffic safety.  The experience with smoking suggests that effective  multi-pronged approaches  include:

 

• State and Community interventions – in other words, laws that do things that make tobacco more expensive, less accessible and limit thing like smoking in restaurants.
• Communication – the goal here is to counter advertising and promotion of tobacco and at the same time promote positive behaviors.
• Cessation – behavior change is key.
• Surveillance and Evaluation – figuring out what works and does not work and how to counter corporate strategies designed to work around regulations.
• Administration and management

Eating is clearly different than smoking.  No one needs to smoke, but we all need to eat so the parallels with smoking prevention and cessation and the obesity/physical inactivity epidemic are not absolute.   However, it seems to me that we are going to have to make it harder and perhaps more expensive for people to make unhealthy food and physical activity choices and do a bunch of other things as well to address this problem (or collection of problems) in a comprehensive way.  It is going to take more than just telling people to eat less and exercise more.

 

3)    What about the Nanny State?   The objections to things like regulating soda size frequently bring up concerns about the so-called Nanny State.    This is a complex topic and relates to just how much control “the government” should have over things that can be framed as individual choices.   On the one hand I am sympathetic to this argument, but on the other hand we live in a complex world and all of us pay a price via things like insurance premiums and taxes for the sub-optimal choices of others.  The Nanny State argument has been used to oppose tobacco control and traffic safety initiatives as well, so expect to see it used in the obesity and physical activity debates as well.  The question of course, is where does society draw the line?

 

In summary, I don’t think the NYC ban will do that much to curb obesity as a stand-alone policy.  However, I do expect this to be the beginning of a long drawn out battle about the regulation of the food industry on issues related to the obesity epidemic.   If the experiences from tobacco control and traffic safety are a guide expect this to go on for the next 30-40 years and expect it to take a long time to see results.    Society did not get fat overnight.

 

This entry was posted on Monday, September 17th, 2012 at 5:56 am and is filed under Current Events, Research and Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.