Taking on Big Soda

Abstract

Restaurants and small businesses around New York City (NYC) began unpacking smaller size cups in preparation for the Beverage Portion Rule—a citywide ban on servings of sugary beverages in containers larger than 16 ounces (475 mL)—which was due to take effect on March 12, 2013. A last-minute decision cut off the plan when a state judge ruled that the portion cap for such drinks was both “arbitrary and capricious”. For example, under this rule, beverages containing more than 50% milk would be exempt, and convenience stores and grocery markets would still be able to carry the larger size drink containers. The portion cap, or “soda ban” as it became popularly known, was a joint effort to combat obesity introduced by the mayor's office and the NYC Board of Health. Citing that the number of obese adults and children continues to rise in NYC—as it has around the globe—the administration joins researchers in attributing the steep incline to the increased consumption of highly caloric, nutritionally devoid food and drink. Exploring the role of ultra-processed food and other factors involved in the escalation of obesity, reports from The Lancet Obesity Series underscore the necessity of implementation of strong and focused public health interventions such as the soda ban. By contrast, in the days since the ban was brought to a halt, the media have been inundated with opinions about what some view as NYC Mayor Michael Bloomberg's overreaching and misguided public health measure. Despite the backlash against the ban, the mayor plans to appeal the decision. Bloomberg, who has been called “the nation's first public health mayor”, has not shied away from controversial public health initiatives. In 2006, NYC became the first to enact a municipal ban on trans fats, which has had an enduring impact on reducing trans fat consumption and has spawned similar bans across America. Although it is likely to be a lengthy battle, there is some hope that the attempt to regulate the portion size of sugary beverages in NYC might encourage other cities and states to follow suit. Finding itself once again under scrutiny, Big Soda, like Big Tobacco, is using its considerable resources to engage in legal campaigns and to curry favour with some unlikely allies—for example, minority advocacy groups. Some advocates have claimed that the soda ban would disproportionately affect minority-run businesses and is a paternalistic approach to curtailing obesity in those communities that have the greatest burden. Companies such as PepsiCo and Coca-Cola, through partnerships with American minority action groups, also actively fund scholarships, conferences, and health and nutritional education programmes. But are these “proactive” efforts on the part of the beverage industry merely a smokescreen to hide the continued targeting of the most susceptible consumers? A report in the 2013 Lancet Series on non-communicable diseases suggests that is the case, and that there is no support for the effectiveness of corporate self-regulation or partnerships with private entities for improvement of public health. Interestingly, in the same week that has seen the bottling of the soda ban, the global Access to Nutrition Index (ATNI) report and rankings were released, representing a new measure for quantification of the voluntary self-regulation and efforts of beverage companies to improve public health. The scores are composites of governance (ie, corporate nutrition strategy and reporting), product formulation and accessibility through pricing and distribution, and corporate commitment to positively influence consumer choice and behaviour. The last dimension emphasises marketing and labelling policies and the stakeholder engagement process. It is here where companies can make a notable impact in communities with the highest rates of obesity—for example, by better articulating policies, through greater transparency in the development and reformulation of products, and by using the already extensive distribution and marketing systems to promote healthier products. With the highest-rated company receiving an overall rating of only 6·3 (out of 10), it is clear that, by this set of metrics in addition to many others, the room for improvement is great. Hopefully, indexes such as the ATNI can be used to increase the buy-in of stakeholders and to monitor corporate behaviour by reinforcing companies with the best business practices and identifying those that fail to improve. Ultimately, however, monitoring is only one part of the equation. It is strong public health interventions that influence the consumption behaviour of individuals—such as the regulation of portion size—and the tenacity of public health-minded officials like Mayor Bloomberg that will truly effect change.