AMA Paper Says Fat Taxes, Soda Bans Make Dollars and Sense

The U.S. considers adding sin taxes as the Danes scrap theirs.

Sept. 18, 2012— -- Taxing or limiting the serving sizes of high calorie junk food may sound like the perfect weapon in the war against obesity, but it seems to have backfired in at least one instance.

Last week, the Danish government announced plans to scrap the tax it instituted just last year on foods high in saturated fats. The reason for the decision: Businesses are bleeding jobs and profits because Danes are crossing the German border to buy their sinful snacks more cheaply.

Despite the Danish experience, legislation to help curb obesity is gaining momentum in the U.S. New York City has led the charge by prohibiting artificial trans fats in restaurant foods, working with manufacturers to limit salt content and most recently, adopting a controversial "soda ban" to limit the size of sugary drinks sold in restaurants and bars.

Thomas A. Farley, M.D., commissioner of the New York City Department of Health and Mental Hygiene and one of the architects of the New York City large soda ban, has written a commentary in the Journal of the American Medical Association (JAMA) explaining why he thinks government regulation of junk food -- and sugary drinks in particular -- is reasonable.

"The balanced and most effective approach is for governments to regulate food products that harm the most people, simultaneously encourage food companies to voluntarily produce and market healthful products, and then provide information to consumers in ways that facilitate their choosing healthful products," he said.

In the commentary he noted that while many foods contribute to excess calorie intake, sugary drinks are among the biggest culprits in the American diet. He said there's been up to a ten-fold increase in serving sizes and a near tripling of consumption of sugar-sweetened drinks since the 1970s to coincide with skyrocketing obesity rates.

"The average consumer now drinks 140-180 excess calories per day in sugary drinks. That's enough to add several pounds a year, every year. Consumption has also been linked with diabetes and heart disease independent of weight gain," he said.

Barry Popkin, a professor in the department of nutrition at the University of North Carolina, agreed there's plenty of data to justify legislation against highly sweetened beverages. In 2010 he published a study in the Archives of Internal Medicine that followed the dietary habits of 5,000 people for more than 10 years, and found that both weight and risk of diabetes decreased in communities where soda and fast-food prices increased.

"We know that if we tax sugar-sweetened drinks at a rate of at least 20 percent -- a few cents an ounce -- it helps lower obesity rates," Popkin said.

Some experts disagree, however.

"The problem is we think if we tax these things people will drink tap water -- they won't," said Brian Wansink, professor of marketing at Cornell University.

Wansink cited a soon-to-be published study in which he asked an upstate New York supermarket chain to place a levy on soda and junk food for a year. As predicted, the extra cost led to lower consumption of those items -- but it also led to a sizable increase in beer sales.

Wansink said that more research is needed to assess the need for government control over other types of junk food as well. Such laws could backfire in a number of ways, he said: People sometimes respond to lower fat and calorie choices by eating a greater number of total calories. They may cut back on healthy foods in order to compensate for the higher cost of their indulgences. Or, as in Denmark, local businesses may pay the price when consumers take their business elsewhere.

Currently trans fats, salt and sugar are the ingredients most often taxed or rationed. Farley said there is strong evidence each of these cause serious health problems. He doesn't see any other foods meeting the same criteria right now. Of course, that could change. And, unlike smoking, where there is one product to tax and regulate, it may be difficult to know where to draw the line.

As for the Danes, Popkin said he thought they gave up on their saturated fat tax too easily. He's disappointed they didn't stick it out longer.

But the Danish government has already moved on. They've asked Wansink to explore more positive ways to encourage healthy behavior. He's currently spending two years transforming supermarkets on the Danish island of Bornholm (population 40,000) to make the sales of healthy foods more appealing for consumers and retailers alike.