JAMA Forum: Tackling Obesity and Learning What Works

Aaron Carroll, MD, MS

Aaron Carroll, MD, MS

Recently, a New York Supreme Court judge struck down the soda ban proposed by New York City mayor Michael Bloomberg last fall. I’m on record in the JAMA Forum as being against the ban in the first place. But I take no pleasure in this setback. Although I think that the policy would not have worked, that was because it had too many loopholes and was too singularly focused.  The judge agreed with me, noting that

… the loopholes in this Rule effectively defeat the stated purpose of the Rule. It is arbitrary and capricious because it applies to some but not all food establishments in the City, it excludes other beverages that have significantly higher concentrations of sugar sweeteners and/or calories on suspect grounds and the loopholes inherent in the Rule, including but not limited to no limitations on re-fills, defeat and/or serve to gut the purpose of the Rule.

This judicial ruling means that such policies are unlikely to gain wide acceptance any time in the future. That’s problematic, as we won’t be able to see if they might actually reduce obesity. I was skeptical but not sure. Natural experimentation on this level can help us learn.

It’s not like other large policies targeting obesity are going to be easy to implement or are guaranteed to work. Some (like me) have advocated that we try a tax instead of an outright ban. This approach has issues, too. In 2011, a tax was implemented in Denmark on foods with more than 2.3% saturated fat. The hope was that this would make people consume less of them.

Unfortunately, there was little to indicate that the tax had much of an effect. It did change people’s behavior, but not in the way that most hoped. Many Danes crossed the border to Sweden or Germany to buy cheaper foods without the tax. Not only did this fail to curb obesity rates, but it also wound up hurting Danish businesses in the process.

The law was repealed last year.

There are other things we can try, such as labeling menus with the calorie content of food items or removing toys from foods marketed to children. It’s possible some of these policies might work. But politics is making that impossible to determine in places like Mississippi:

A bill on the governor’s desk would bar counties and towns from enacting rules that require calorie counts to be posted, that cap portion sizes, or that keep toys out of kids’ meals. “The Anti-Bloomberg Bill” garnered wide bipartisan support in both chambers of the legislature in Mississippi, the state with the highest rate of obesity in the nation.

Although it’s being billed as an “anti-Bloomberg” measure, this bill goes too far. Research has shown us that some things (such as calorie counts on menus) don’t necessarily work when it comes to obesity, but other things (such as offering smaller portion sizes of a high-calorie dish) do show promise. If we refuse to engage in any attempts at all, we will fail to learn what works and what doesn’t.

That’s the biggest problem with what’s being proposed in Mississippi. It’s not that the state is repealing a law that they don’t like. They’re instead actively preventing any towns or counties from passing any laws to curb obesity at all. It’s an effort to shut down all attempts.

If we don’t try, we will never succeed.

It’s not surprising that this bill was pushed by the restaurant association, small business and beverage groups, and the “chicken farmers’ lobby.” They stand to profit from continued food and drink sales. But what’s good for them may not be good for Mississippi. The state has the highest rate of obesity in the nation; more than one-third of residents are obese, and many more are overweight.

All is not lost. When I first expressed my belief that the soda ban would do little to reduce obesity as an actual policy, because there were still plenty of ways to consume calories in New York City, many expressed a belief that the law was more of a symbol than an intervention. By bringing to light and focusing on the unhealthy nature of sugared beverages, the ban might have encouraged many people to choose on their own to consume less of them.

If that’s the case, then the repeal of the law might have served a similar good. Martyring the attempt to ban unhealthy beverages has brought even more attention. The repeal might do just as much good as the policy itself.

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About the author: Aaron E. Carroll, MD, MS, is a health services researcher and the Vice Chair for Health Policy and Outcomes Research in the Department of Pediatrics at Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

About The JAMA Forum:  JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.



Categories: Diet, Health Policy, Obesity, Public Health, The JAMA Forum

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