I spent Sunday with my daughter at Philadelphia’s “Boo at the Zoo!” Picture thousands of costumed kids descending on the zoo to see the animals and visit the treat stations. As a point of information, there were many people dressed as animals, which I found entirely confusing depending on one’s vantage point, animal or human. Note that the orangutans were eating lettuce, the giant tortoises feasting on tomatoes, and the prairie dogs munching on carrots. We feed them nutritious food because we want them healthy, right? At the end of the day, her bag was loaded with a mix of healthy snacks (thanks Philadelphia!) and of course, candy. Hey no worries, I am decidedly not the Grinch who stole Halloween! I have already witnessed the yin and yang of food in my life.
After recently blogging about formative years spent imbibing Hawaiian Punch (I heard from many fellow punchers), it was all the more interesting to be a guest lecturer last week at Drexel’s Great Works Symposium. The title I was assigned: "a City Sin Tax: Obesity Prevention or a City in Distress?" I began by wondering out loud if we could consider an obese City to be one in “distress." At the podium during one of our events last week, Mayor Nutter commented that 57% of children and 64% of adults in our City are overweight or obese (by accepted BMI measurements). If you think this issue is limited to Philadelphia, you’re wrong. Given current obesity rates, 86% of American adults will be either overweight or obese by 2030. It’s a game of endless numbers: calories in, calories out; BMI; age; socioeconomic status; ounces in the bottles and cans; amount of sweeteners in the ounces; market share and more.
In preparing for the lecture, I had to review a significant amount of data-- volumes of it that most people have no time to consider. The more I read, the more alarmed I became. The issue of taxing what the USDA appropriately calls "calorie-sweetened beverages" (CSB) has been hotly debated and politically defeated in this country for several years and while the debate rages on, our waistlines widen and the related national health care bill grows. There is seemingly no end in sight.
If you ever wanted to explore a complex public health issue, take a look at personal food choices. What we reach for depends upon many factors including:
socioeconomic status (poverty as always, is the great determinator),
where we live (connected to race and poverty),
our deep belief in personal choice and its relation to data you understand,
choices available/presented to you in your environment (healthy vs. unhealthy default choices),
marketing – connected to culture, age, where we live and more, and
calories out – that’s right, exercise (the ability to do it, presence of accessible and safe spaces, time… in a world where the latest technology allows us to remain endlessly seated for entertainment, socializing and work).
Complex indeed, but at the end of any day the data astounds:
Caloric-sweetened sodas and fruit drinks (containing less than 100 percent juice by volume) are major sources of added sugars in American diets, contributing an average of 10.58 tsp of added sugars each day. Picture one teaspoon = one sugar packet = one sugar cube. Since data in the form of graphs, percentages and serious journal articles isn't making much of a dent, try this: A single 20-ounce soda, a common size these days, contains about 16 teaspoons of sugar = 16 packets. My scientific reaction -- OMG! And hey, if you drink one, 20-ounce bottle of soda daily, you can gain up to 15 pounds annually. (Yep, drop the beverages, drop the weight).
The average American consumes 44.7 gallons of soft drinks annually. Of the 278 additional calories Americans on average consumed per day between 1977 and 2001, more than 40% came from CSB. Data suggests that soda accounts for 10% of the total average calories a child consumes daily and that a child’s risk of obesity increases 60% for every additional sugary drink consumed per day. Soda is non-satiating - it does not produce a sensation of fullness, leaving the drinker hungry for more. Water, as an example, is filling and you're good to go.
Consumer prices for soda from 1985 to 2000 increased by 20% while during the same time, the price of fruits and vegetables rose by 117%. Soda is the least expensive beverage you can purchase and you can purchase it just about anywhere.
Obesity and overweight persons have associated morbidity that account for a significant percentage of the overall national health care bill. Health-related obesity costs are projected to reach 344 billion by 2018. Associated conditions are predominantly diabetes, heart disease and certain malignancies. These are the facts.
So here it is: A national penny per ounce excise tax could decrease consumption by up to 23 percent; reduce health care costs by $50 billion over 10 years and potentially generate $150 billion in revenue over 10 years to be used for, among other things, public health prevention and intervention programs. Industry could spread the tax over all its products which often include diet beverages and water. Jobs don't have to be lost at all. Industry could make new, healthier products.
But the controversy continues. Some point to corn and corn subsidies as the root of all problems. The students at Great Works last week wondered about everything from the Farm Bill to considering letting "the people" vote. Still others talk about free choice and wonder what will be taxed next. The arguments, pro and con, are persuasive and passionate. Take a look at the nation’s wonderful health resource for reviewing dietary recommendations and then ponder our collective future. We have to try something people, what should it be?