The American Medical Association (AMA) voted today to endorse taxation of sugary beverages as a means to raise money for anti-obesity programs. Interestingly, a recent physician survey at Medpage Today suggests that only 50% of physicians think that a soda tax is an effective public health strategy.
I am one of the 50% who feels that this policy will not be effective. In short, this is why:
1. You can become obese by eating and drinking almost anything in excess. Targeting sugary beverages is reductio ad absurdum. Did America become fat simply because of an excess supply of sugary fluids on grocery shelves? What about the super-sizing of our food portions, the change in workforce physical requirements, the advent of cars, escalators, healthy food “deserts” in poor neighborhoods, video games, and cutting gym class from schools?
Holding Coca Cola, et al. responsible for our own over-consumption of calories is both unfair and tantamount to spitting into the wind – something bad is going to come back at us. Consumers can easily get around the soda tax by buying sweet alternatives – which may have even more calories than soda. (Caramel latte anyone?) And then what? Are we really going to play public policy, food and beverage whack-a-mole?
2. You can be thin and fit while eating and drinking almost anything. Obviously nutrition science has shown that a diet rich in fresh fruits and veggies, lean meats, low-fat dairy, whole grains, and healthy fats is the best for our health. However, please consider that the world’s fastest woman, Olympian Carmelita Jeter, eats Hostess cup cakes, Teddy Grahams, Welch’s grape juice, whole milk, and Gatorade. How do I know? Because she posted a photo of her shopping cart on Twitter (see image to the left). I obviously have no idea how much of this she eats – or when she eats it – but if the world’s fastest woman is powered (to some degree) by “Twinkies” then I think we should all think twice about demonizing certain foods/beverages in our anti-obesity fervor.
3. You can’t regulate good behavior. Human behaviors that may lead to obesity are simply too complex to regulate. Who would want to live in a world where government becomes the de facto “Nutrisystem” for its citizens, mailing out pre-packaged, ingredient-controlled meals to 312 million people per day, three times a day, seven days a week? While that may save the post office from its imminent demise, we can neither afford to do that, nor do we need to.
People who believe that policy should drive behavior point to smoking bans that have cut down on smoking rates. While I agree that small improvements have been made in reducing smoking rates, roughly one in four people still smoke (depending on your source, this number could be as low as one-in-five), and one in every five deaths is still attributed to cigarette smoking. Hardly a resounding victory, alas.
But beyond the fact that policy changes (and the billions we’ve spent enacting and enforcing them) have resulted in a disappointing decrease in smoking rates, is the issue that cigarettes and food ingredients (such as sugar) are not analogous substances. While there is no safe minimum amount of cigarette smoke, our bodies need salt, glucose, and fat to survive. They cannot be cut out of our diet completely – nor should they. And the only way to force people to optimize their intake is to enact Draconian measures.
So instead of starting a food-fight, it’s important to accept the complexities associated with this particular health scourge and promote a broader, more-nuanced approach to wellness incentives. We have to attack this problem from the ground up, because a top-down approach requires our government to become an invasive, food and exercise nanny.
The good news is that one-third of Americans are not overweight or obese, despite our current “toxic” food/inactive lifestyle environment. Perhaps these thinner folks can be ambassadors for the rest of us, and reveal their secrets of healthy living despite our current limitations. Even with our best efforts, we need to understand that (like smokers) we will always have a segment of the population that is overweight or obese.
And as for the Olympians among us – they help to illustrate that obsessing over every morsel of food or cup of soda that we consume is not the way forward. Sorry AMA, I’m with Carmelita on this one.