It's a big goodbye to the big soda in the Big Apple. New York City Mayor Michael Bloomberg's proposed ban on large-sized sweetened beverages was approved today by a Board of Health vote.
Many have criticized the proposal as being impractical (and, hey, count me among them). But there's a deeper problem: it's philosophical underpinnings.
For years, public health advocates have openly -- and selectively -- tried to demonize soda companies in language that compares them to cigarette companies. Yale's Kelly Brownell claims that "[soda companies] are using many of the same tactics that tobacco companies used." Heavy rhetoric? Dr. Thomas Farley recently made a similar point -- he's New York City's health commissioner, by the way. Google "soda" and "new tobacco," for the record, and you get over 7 million hits. Even investment writers are starting to buy (or sell) the corporate blame game, as seen in a recent post on The Motley Fool. The rhetorical cycle has gotten so out of hand that one author recently claimed that drinking soda is worse than smoking, joining a growing list of advocates who claim that sweetened sodas are toxic.
If the fight's the same, it follows logically, then the policy prescriptions should be the same, too. So public health officials are consciously comparing their strategy of rules, regulations, and taxes on soda to those used against tobacco addiction; New York City's vote today is one result. Papers and essays linking anti-tobacco strategies to obesity are all too common, yet few provide evidence that these strategies will work against a different target. It is, as the military would say, a classic case of fighting the last war.
Let's be clear: there is an obesity epidemic and we need to reverse rising rates of obesity for the sake of our health and our health care system. But it's a mistake to believe we should take the same approach with obesity as we did with tobacco.
Here are five reasons why:
OBESITY IS A CONDITION. TOBACCO IS A PRODUCT. You can drink soda, eat cake or enjoy the occasional burger and still maintain a healthy, balanced diet. Millions do. However, there's no healthy amount of tobacco.
ADDICTION. Nicotine is inherently physiologically addictive. Few foods or beverages come close. While some studies attempt to suggest otherwise, the evidence simply isn't there to support the idea of fast food addiction. Most people who are "addicted to food" are addicted to a habit, not to a product. Coke tastes good but it's not a cig.
POLICY COMPLEXITY. Tobacco use is easy to regulate, since it's hard to hide a burning cigarette. Tobacco is easy to tax, since cigarettes were always made in standard sizes by a small cartel of companies. In fact, cigarettes are so taxable that the first federal cigarette tax was levied in 1864, a full century before the Surgeon-General conclusively linked cigarettes with increased cancer.
Food is not so simple. Do you tax calories, or added sugar, or fat? Do you tax soda? Or do you tax all sweetened beverages, including healthy sweetened juices like cranberry juice? If you want to restrict large sizes for sweetened beverages ala Bloomberg, what do you do about milkshakes or lattes?
SECONDARY SMOKE. Laws pushed smoking out of most public facilities and (literally) into the cold. There was widespread public support for these measures, even among smokers, since evidence showed clear risks of cancer and respiratory illness from exposure to second-hand smoke. There is no direct risk from being in close proximity to your neighbor's fries or his Pepsi.
THERE ARE NO DIET CIGARETTES. There can be reasonable debate about the health and market impacts of diet sodas. However, the important point is that a no-calorie beverage is a no-calorie beverage -- nothing like the infamous 'low tar' cigarette claims of tobacco companies to deflect health criticisms. And the argument (made, for instance, in The Motley Fool) that soda makers bear direct responsibility for peddling sugar to their consumers? Nonsense. Big Tobacco turned nicotine addiction into a business model while beverage companies could care less if consumers buy drinks with zero calories or drinks with 1,000 calories. Soda companies are pushing soda, not sugar.
If we want to reverse the obesity epidemic -- as we must -- then the policies we choose must be more nuanced and more positive. Copying the heavy-handed war on tobacco, as Mayor Bloomberg is doing with his war on soda, will fail.
But don't expect the Tobacco 2.0 attitude to change any time soon. After all, the lure of instant gratification is as common in public health circles as it is in your favorite pizza place.