Are large sugary drinks a health risk or a civil rights concern?
That's the debate set off by New York City Mayor Michael Bloomberg's proposal to restrict the sale of sodas and other sugar sweetened beverages to 16 ounces or less.
Advocates on both sides of the issue faced off at a public hearing Tuesday in Queens.
Beverage companies, their advocacy groups and some consumers vehemently object to the ban. Aside from the obvious reason that it will cut into profits, they claim it will limit choice and amounts to "nanny state" policing of personal nutrition.
"While we feel the mayor has good intentions, his proposal seems arbitrary," said Eliot Hoff, a spokesperson for New Yorkers for Beverage Choices, a group that receives a portion of its funding from the National Beverage Association. "We believe that we can choose what we drink and how much we drink."
Should the proposal be adopted, it would only apply to establishments under the supervision of the Department of Health, which includes restaurants and movie theaters but not grocery and convenience stores. So any business that receives a letter grade from the city could not sell super-sized drinks under the proposed rules -- but the 7-11 or bodega right next door could continue to sell Big Gulps.
This did not sit well with many of the 100-plus people who attended the hearing, including most of the elected officials who spoke on behalf of their constituents. Even as he expressed admiration for the Mayor's ongoing commitment to health, Daniel J. Halloran, councilman for the city's 19th District in Queens, warned that small business owners would be unfairly penalized by the ban. He called the initiative "absolutely ridiculous, unenforceable and hypocritical."
Others objected to consumers being forced to buy two smaller drinks at a higher cost if 16 ounces didn't quench their thirst. This, they said, will stretch the already tight budgets of New Yorkers.
"Families who typically share one large drink will no longer be able to do so and will definitely wind up paying more," said Hoff.
On the other side of the aisle, groups like the Center for Science in the Public Interest (CSPI) said it's about time someone addressed the ballooning portion sizes of sweetened beverages.
"For more than 100 years, the soda industry has had free reign and for many years it was not a problem because people mostly drank in moderation," said Michael Jacobson, CSPI's co-founder and executive director. "Now container sizes have jumped and the marketing of these drinks -- especially to adolescents -- has exploded to more than $2 billion a year."
The current default container size for a soda is a 20-ounce bottle, more than triple the 6.5-ounce size that was once standard. And that's tiny compared to McDonald's 32-ounce serving, Burger King's 42-ounce serving and the 54-ounce soda sold at Regal movie theaters.
When you factor in sports drinks, sweet teas, vitamin waters, and energy drinks, Jacobson and other health experts who attended the hearing say it's no surprise the average person drinks 40 gallons of sweetened liquids per year.
"Adolescents consume twice the average amount, and there are some people who drink three times the average amount," said Dr. Walter Willett, chairman of epidemiology and nutrition at Harvard Medical School. Willett said that sugary drinks are now the single greatest source of added sugar in the American diet, and they offer no nutritional value. Therefore, he said, they're appropriately the number one target in the fight against obesity.
The Bloomberg proposal has no precedent; this is the first time a U.S. city has so directly attempted to limit sugary-drink portions. Even the experts in support of the size limit say it's impossible to predict whether it will help cut sugar and calorie consumption or make an impact on the percentage of obese New Yorkers.
However, Bloomberg and his supporters say the data are on their side. They point to the success of other ongoing initiatives such as the posting of calorie counts on menus and the trans-fat ban as models of how effective the super-size ban could be.
"If people shifted from one 20-ounce serving to a 16-ounce serving just once a week, this could potentially prevent an estimated 2.5 million pounds of weight per year," Jacobson said.
Kelly Brownell, director of the Rudd Center for food policy and obesity at Yale University, cited research linking increasing portions of sugared beverages -- as well as soup and foods such as macaroni and cheese, sandwiches, pasta, and potato chips -- to a 25-50 percent increase in overall consumption. Worse, he said, liquid calories don't create the same feeling of fullness as solid foods do, so consumers often don't make up for the excess by cutting back at subsequent meals.
People also tend to consume food in the size the bag, a bottle or a box it comes in, a phenomenon known as unit bias. When packaging is larger, people consume more. With the steady growth in package sizing over the last few decades -- especially soda bottles -- this has consumers unconsciously eating more than they intend.
However, many obesity researchers say limiting drink sizes is a useless gesture that gives a false sense of accomplishment.
"It's never been definitively shown that the obesity epidemic is due to drinks larger than 16 ounces," said Nikhil Dhurandhar, an obesity researcher from Pennington Biomedical Research Center in Louisiana. He did not attend the hearings but is familiar with the Bloomberg plan.
He said there is no way to compartmentalize eating and that limiting or removing a single food from the diet is no guarantee it won't be replaced by another source of calories.
"It's like digging a hole in water. If you take away one thing, it's likely to be replaced."
Indeed, studies by the Centers for Disease Control have not indicated a definitive link between soda consumption and obesity. And a recent study published in the Journal of Behavior Nutrition and Physical Activity found that when schools eliminated unhealthy foods and beverages from campus, children did make healthier choices -- but obesity rates didn't decline and were no different from schools without such bans.
Regardless of where they stood on the issue, just about everyone who attended the hearing conceded that Bloomberg's proposal was likely to pass when it comes up for vote this September by a panel of health experts handpicked by the mayor himself. If the rule is adopted, it will go into effect in March 2013. Establishments that violate size limits can be fined by up to $200 per violation.
In addition to the public health policy experts represented at the meeting, a slew of celebrities, including chef Jamie Oliver, filmmaker Spike Lee, and former president Bill Clinton have publically supported the Bloomberg initiative.
Still, some said the ban could be a slippery slope.
"What will they be telling me next," councilman Halloran wondered. "What time I should go to bed? How many potato chips I can eat? How big my steak should be?"