There’s been a buzz about fizz in NYC after Mayor Bloomberg set out to ban the sale of large sodas from restaurants and the like in early March. And by “large”, he means greater than 16 ounces (almost 500ml). From a public health standpoint, irrespective of obesity rates, it’s hard to be an advocate for the consumption of one-gallon sodas (7-11 big gulp* = 128 oz = one full gallon = ~1,500 calories). As a point of comparison, a 16-ouncer of Coke is ~200 calories and a large at McD’s (32 oz) is 300. So if we know that the stuff is just short of poison, why did a State Supreme Court Justice shut the law down last week, calling it “arbitrary and capricious?” Is this about health or about business? And moreover, can the two co-exist?
* Ironically, the Big Gulp would not have been banned since it comes from a grocery store of sorts (7-11). Also, drinks with at least 50% milk would not have been banned because they provide “nutrients” (as opposed to empty calories). Rest assured, you would have still been able to get your macchiato du jour before class (which is, by the way, ~350 cal).
As a society, we insidiously tolerate larger and larger soda sizes. A soda from McD’s in 1955 was a mere 7 ounces, which is ~18 times smaller (!) than a Big Gulp. People are walking around drinking buckets of sugar water and somehow we don’t stop in our tracks, aghast at the site. Though it’s not exactly smoking out of your tracheostomy tube…or is it?
Although most New Yorkers and folks I’ve talked to oppose Bloomberg’s ban (including classmates), I’m still conflicted. More than 50% of New Yorkers are obese (with a BMI at least 30 kg/m2) and the numbers who die from health problems “related to obesity” is ~5,000 (roughly equal to the number of undergraduates at Columbia to put in perspective). Further, more than a million New Yorkers have been diagnosed with diabetes (and almost half that are undiagnosed) per NYC DOH. Hard for us to imagine, but many people don’t equate drinks with food and don’t understand they contribute to weight gain. DOH campaigns on subway cars educate otherwise with provocative signs stating, “Are you pouring on the pounds? Don’t drink yourself fat” and the like. But it’s not clear if these signs impact behavior.
Can we trust people to do the right thing? Is it over-bearing and paternalistic to say, “no – we can’t”? But high risk and costly to say otherwise?
We discussed the book Nudge by Richard Thaler and Cass Sunstein in our Social and Behavioral Science class, which introduces the idea of “libertarian paternalism” and “choice architecture.” Although the Times called the book “a bit wearisome,” The Economist named it “Best Book of the Year” (since we love our econ profs, I will refrain to comment on this…other than to agree that it’s a fantastic book). The idea behind libertarian paternalism is that one can employ behavioral nudges to influence behavior and choices while not actually taking away the power of choice. Like automatically renewing magazine subscriptions for example, which give you the choice to call and cancel (active) or continue to subscribe year after year (passive). Or like having an HIV test done at a hospital under protocol (passive) unless you “opt out” (active). In these cases, people will more likely follow the passive route. But they weren’t robbed of their ability to choose. This is also the idea behind “choice architecture,” a phrase you should most certainly use at dinner in spite of risk of being called “bookish” (to put it nicely).
Thaler and Sunstein argue that we can take advantage of this psychological inertia, if you will, in order to nudge people into behaviors. This just might be a better approach than Bloomberg’s all out ban. There’s no doubt that the same corporations that opposed the ban will oppose the nudge (and similarly threaten to decrease funding for NAACP and the like), but it won’t evoke quite the same outcry from folks who value individual rights.
At the end of the day, if no ban, we need to nudge. Expecting the powerful food industry to compromise profits and grow a conscience is unrealistic at best. As a public health community, we have to continue the discussion around health vs. free will to be unhealthy and the societal consequences of the later.
In the mean time… as long as the evidence falls favorably on red wine, dark chocolate, and olive oil, I’d gladly trade away my big gulp for these indulgences.