Soda ban gives doctors entry point for talks about weight issues

Most of the children pediatric endocrinologist Anita N. Swamy, MD, cares for in Chicago are obese or overweight. Many don’t know what “healthy eating” means. Some have never even had fruits or vegetables.

“If you tell someone, ‘I want you to eat better,’ they have no idea what you’re talking about,” said Dr. Swamy, medical director of Chicago Children’s Diabetes Center at La Rabida Children’s Hospital.

She says patients need something more concrete, which is why she plans to talk with them about New York City’s recent ban on large sodas and other sugary beverages at certain food establishments. It is the first such ban in the country.

On Sept. 13, the New York City Board of Health approved a ban on sodas and other sugar-sweetened beverages larger than 16 ounces that are sold in food service establishments regulated by the city’s Dept. of Health and Mental Hygiene.

Sugary drinks are defined as nonalcoholic beverages with more than 25 calories per eight ounces. Beverages that are more than 50% milk or 100% fruit or vegetable juice will not be affected. Establishments where large drinks will be banned starting March 12, 2013, include delis, mobile food carts, movie theaters, restaurants, stadiums and arenas.

New York internist Susan Kansagra, MD, MPH, encourages doctors to use the ban as a starting point for conversations with patients about the importance of regulating portion sizes for food and drinks.

“It’s hard for patients to think of concrete steps to achieve weight loss. Physicians can think of [recommendations of smaller portion sizes] as very tangible advice they can give their patients,” said Dr. Kansagra, assistant commissioner in the Bureau of Chronic Disease Prevention and Tobacco Control at the New York City Dept. of Health and Mental Hygiene.

She added that such discussions could help prevent not just obesity but also the development of chronic diseases, including diabetes.

Link between sugary beverages and weight gain

One in three U.S. adults is obese, as are 17% of children and adolescents, according to the Centers for Disease Control and Prevention. The prevalence of obesity in youths has nearly tripled from 1980, when about 6% were obese, the CDC said. Health professionals say drinking sugar-sweetened beverages plays a significant role in the nation’s widening waistline.

The American Heart Assn. recommends that most women consume no more than 100 calories per day from added sugar, and no more than 150 such calories a day for men. A 12-ounce serving of most sugar-sweetened beverages typically has 130 to 150 calories of added sugar, according to a report issued in June by the American Medical Association’s Council on Science and Public Health.

Complicating matters is that the size of sugary drinks has ballooned from a standard 6.5-ounce or 8-ounce size in the 1960s to 20, 32 and even 64 ounces today, said Thomas A. Farley, MD, MPH, in a commentary published in the Sept. 19 theme issue on obesity in The Journal of the American Medical Association.

“The increase in portion sizes of these beverages is important, because studies consistently show that when people are offered larger portions, they simply consume more without recognizing it and without compensating for the increased consumption by decreasing intake later,” Dr. Farley wrote in response to the ban’s passage. He is commissioner of the New York City Dept. of Health and Mental Hygiene.

Multiple factors contribute to obesity, including genetic makeup, a lack of physical activity, eating fattening foods and consuming too much food. But several studies published online Sept. 21 in The New England Journal of Medicine show a link between drinking beverages high in sugar and weight gain.

In one such study of 224 Boston-area overweight and obese adolescents, those who replaced the sugar-sweetened beverages they usually consumed with nonsweetened alternatives, such as water, had significantly smaller increases in body mass index after one year than same-age peers who continued drinking sugary beverages.

“These randomized, controlled studies & provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity,” said Sonia Caprio, MD, in a commentary published in the same NEJM issue as the recent obesity studies. Dr. Caprio is a professor of pediatric endocrinology at Yale School of Medicine in New Haven, Conn.

The New York ban, however, has sparked criticism from the food and beverage industry, including the National Restaurant Assn. and other organizations and individuals. Among the chief concerns are that the regulation infringes on people’s freedom of choice and will negatively affect restaurants by preventing them from serving large sugar-sweetened drinks.

The restaurant association said the ban “unfairly targets restaurants and is a misguided tactic to impact the obesity problem.”

“This proposal creates an uneven playing field from a business perspective and produces a false sense of accomplishment in the fight against obesity,” the association said.

But many health professionals agree that the recent restrictions will raise awareness among the public and the medical community about the negative impact of sugary beverages and large portion sizes on a person’s weight.

“This is the kind of [regulation] that’s significant, because it’s symbolic,” said Steven M. Safyer, MD, president and CEO of Montefiore Medical Center in New York. “It gets everyone’s attention. It’s focusing on the fact that people are drinking gargantuan amounts of soda, and it never satiates them.”