When you train to become a doctor at a time when more than 50 percent of the population is overweight, your eyes start playing tricks on you. You compare your clinic notes with the appearance of your patients, and words like “severely overweight” and “moderately obese” just don’t seem to fit. These words imply some deviation from a norm – but these states are the norm. You accept historic rates of obesity as the default – because for this generation, they are.
The passage of New York City’s controversial soda ban last month has reignited debates about how to address the nation’s obesity epidemic. The New York City law restricts the sale of sugary beverages in containers larger than 16 ounces in movie theaters, fast-food restaurants, sporting arenas, and other food establishments regulated by the city. Exempt from the ban are beverages sold in convenience and grocery stores, as well as fruit juices, diet sodas, and dairy-based drinks. Massachusetts would do well to consider a similar proposal.
Massachusetts has a history of trend-setting health initiatives that have resulted in a well-insured and (relatively) healthy populace, but even here obesity has taken a disturbing toll. The obesity rate in Massachusetts has doubled in the past 15 years, leading to large increases in associated conditions like diabetes, heart disease, and hypertension. Rates of childhood obesity have nearly tripled in the past three decades. And a recent study by Trust for America's Health and the Robert Wood Johnson Foundation estimates that by 2030, half of all adults in Massachusetts will be obese.
The size of American waistlines has grown in concert with the size of American sodas. In the 1950s, the largest soda sold at McDonald’s was 7 ounces. Today, a “child size” is 12. The default “small” at most fast-food restaurants is now 16 ounces, and health-conscious Subway offers only 21-, 32-, and 44-ounce options. Regal Cinemas boasts a 54-ounce large with a whopping 175 grams of sugar. That’s more than 40 teaspoons. Free refills. All in all, the average soda in the United States is 6 times larger than it was 50 years ago, and the average American is 26 pounds heavier.
So is a soda ban the cure for our obesity epidemic? Of course not.
Our current epidemic is a complex, multifaceted problem that developed over the course of decades. There is no silver bullet. But there is good reason to believe that bans such as New York City’s are a bold step in the right direction. Soda is the single greatest source of added sugar in the American diet and consumption has tripled since the 1970s. Adolescents today consume up to 15 percent of their calories everyday from sugary beverages and fruit juices. And liquid calories seem to be processed differently from those in solid foods so people don’t feel as full after drinking calories as they do after eating them.
But the true value of a large soda ban is not in limiting the number of nutrition-less calories Americans gulp down at movie theaters and fast-food joints. After all, people are not restricted to buying just one soda – if you want to buy two (or three or four) sodas, that’s your prerogative. Heck, stick a straw in a 2-Liter and be on your merry way. No, the ban’s true significance comes from thrusting the issue of portion sizes squarely into the public consciousness. It comes from forcing individuals to make active choices to consume more, rather than reflexively accepting stealthily and steadily swelling dimensions of food and drink. It comes from taking the first step toward resetting our cultural defaults.
The portion size of almost everything has increased over the past several decades. With profit margins of up to 90% on products like sugary beverages, it’s not hard to see why. The result is that we find ourselves in a food environment that strongly encourages vast overconsumption of unhealthy foods.
This overconsumption has serious consequences – both for the health of our population and the health of our medical system. Obesity-related diseases cost the healthcare system an estimated $147 billion every year, and account for about 10 percent of all medical costs. Obese individuals spend 42% more on healthcare than do people in a normal weight range. Massachusetts recently sent a strong message about controlling medical costs with its first-in-the-nation health-spending cap, which seeks to limit overall health spending so it grows no faster than the state economy. But this cap must be accompanied by a larger conversation about obesity and disease prevention if it’s going to be effective. We can’t cap our massive spending until we start capping our massive sodas.
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