Blog | Thursday, October 18, 2012

Big Apple bans big soda: big deal?

Now that the New York City Board of Health has ratified Mayor Bloomberg's plan to ban sugar-sweetened beverages (well, some such beverages, really) larger than 16 ounces, we should be able to answer the question: Is this a big deal?

Honestly, no one knows.

Staunch advocates of the ban are certainly correct that something more needs to be done about epidemic obesity. Its toll is unsustainable, whether the currency is human cost or dollar cost.

And they are also correct that this ruling hardly tramples on any inalienable rights. In the annals of human oppression, the need to buy two sodas rather than one if you simply must have 32 ounces of sugary liquid to wash down your burger and fries, let's face it, doesn't even register.

But what we don't know is whether or not this will advance the cause. If, in fact, people simply do buy two 16-oz. sodas routinely, the ban will accomplish nothing. If people drink the same total volume of soda, but spread out over the course of the day, the ban will accomplish nothing. If people buy larger sodas at the many New York City venues where the ban does not apply, the ban will accomplish nothing. If people replace the calories and sugar with other sources, the ban will accomplish nothing.

And if people switch from slightly larger but less sugary drinks, now banned, to slightly smaller but more sugary drinks, the ban will have unintended consequences.

There is also the risk of, to put it very bluntly, pissing people off. I don't mean the people working for the American Beverage Association, whatever made-up organization they are disguising themselves with during any given week. And I don't mean those who think the existence of the Environmental Protection Agency is an assault on civil liberties and testimony to a nanny state. In my opinion, people who go that far are either ninnies or have something to sell.

No, I mean it may piss off perfectly reasonable people who legitimately see in this a slippery-slope concern. Why just the size of soft drinks, and not the size of the burger, and the fries, and then the whole lunch? And then why not breakfast, and dinner? And then ...

This concern may not be valid, but it's hard to tell. I certainly know Mayor Bloomberg's intentions are pure, but the whole point about the lid on Pandora's box is you don't get to pick and choose what comes flying out. If public health turns the formerly ambivalent into a riled-up opposition, we could go backward rather than forward. Will that happen?

No one knows.

Here are a few things we do know. Gertrude Stein famously told us that a difference, to be a difference, must make a difference. Now that the ban is policy, the only meaningful verdict can come from data. We need to pass judgment on the effects it has.

Martin Luther King wisely pointed out that our means should be as pure as our intended ends. So even if the ban has favorable effects, it doesn't reliably tell us these were the best or only means to such ends. But in the absence of intended ends, means mean nothing.

If the ends are as intended, it will lend support to the "we needed to do something" argument. With that established, and "do nothing" eliminated as an option, it will still allow for a consideration of what means to such ends are best.

That quest for ends must be conducted carefully, however. We also know--or should--that no one thing we do will "fix" epidemic obesity. So we need to look at reasonable outcomes, and not expect this one policy to get us all the way to the prize any more than we can expect a single sandbag to do the job of a whole levee. If the ban reduces sugar and calorie intake even a little, it will have made a difference that matters.

Passions--some genuine, and some doubtless merely bought and paid for--run high on both sides of this debate. But the soda ban is a done deal. To determine if it's a big deal, and a good deal, we need data. To reach a verdict in the court of public opinion, we the jury should wait for effects, stifle our passions, and let epidemiology trump ideology.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.