A Spoonful of Tax (Makes Obesity Go Down)

As I walk into my primary care clinic and greet my patient, I notice she is drinking a soda while she waits for me. She looks at her baby daughter, who is also my patient, and tells me:

"I know soda isn't healthy but the baby loves it. Sometimes I give her sips of it when she's crying."

The mother has a body weight that places her in the "extreme obesity" category. I was in the operating room during her cesarean section when her daughter was born. In the 15 months since that cesarean, her daughter's weight has climbed greater than the 95th percentile for her age. Stories like this are common in primary care medical clinics. I know that Mom wants her baby to be healthy, and I want to be able to help.

The availability and marketing of soda are part of the problem, even within our own health system. Each morning, I pass by the vending machines selling sugary beverages on the ground floor of our health clinic. These are still here, despite Mayor Gavin Newsom's 2010 executive order that they are to be banned from city property.

Today, one in four Californians is obese. If we continue along this trajectory, the obesity rate is expected to climb to close to 50 percent by 2030. As a primary care physician, I see the impact of obesity every day: a young obese woman who develops diabetes during her pregnancy; a twelve year old overweight boy is bullied in school and is depressed; a seventeen year old girl has high blood pressure and high cholesterol; a sixty-two year old man suffers from heart disease and debilitating arthritis.

Obesity is preventable and curable. Studies continue to confirm sugar as a major culprit in this epidemic. Sugar has addictive properties, and when consumed in excess, disrupts our bodies' metabolism in negative ways leading to diabetes, high blood pressure, high cholesterol, and heart disease. Obesity is not only detrimental to our physical health, but is also expensive and the United States now spends $190 billion per year treating obesity and related chronic diseases.

One small step California can take to combat this growing public health problem is to enact a tax on sugar-sweetened beverages so that the price of soda begins to reflect its true cost to society. This strategy worked with tobacco -- tobacco taxes contributed to a significant reduction in smoking rates in this country.

State Senator Bill Monning (D-Carmel) recently introduced Senate Bill 622 to tax a penny per ounce of sugar-sweetened beverages and to use the money gained from those taxes to fund obesity prevention and treatment programs. Anyone who wants to reduce the incidence of obesity should strongly support this tax.

Evidence shows the tax will work. A study published last year by researchers at Columbia and UCSF demonstrated that a nationwide penny per ounce tax would reduce consumption of sugary drinks by 15 percent, reduce obesity and diabetes rates, and save the healthcare system $17 billion. Imagine if a pharmaceutical company developed a drug with that kind of impact. Not only will the tax help reduce consumption, but it will also be an opportunity for a massive public health education campaign.

Opponents argue that the tax will not work, that it will unfairly burden the poor, or that it will create a "nanny state." Their arguments are well-funded by Big Soda and the American Beverage Association, which last year spent about $3.5 million in lobbying efforts to defeat soda tax initiatives in Richmond and El Monte.

Our focus must be on the growing burden of obesity in this country and on finding an effective solution. Just as the government stepped in with tobacco at a critical time, we need this intervention to improve our public's health. We can no longer tolerate the prioritization of profit over health. Consumers will ultimately be paid back through improved health and lower health care costs.

California is suffering from an epidemic of obesity and we need meaningful, evidence-based changes in our consumption and activity patterns. A soda tax is a small but important step towards changing consumption, and should be part of a multi-faceted approach to combat obesity.

What can you do? Write your representative to support this bill. Ask your doctor why they still sell soda in the clinic vending machines. Or better yet, vote by saving your dollar -- drink water, not soda.

Christina Palmer, M.D. is a second year resident at the University of California San Francisco Family & Community Medicine program. This essay was written as part of the residency program's Writing for Advocacy curriculum.