Food

One City's Crusade to Fight a Leading Cause of America's Childhood Obesity Epidemic

Baltimore may become the first U.S. city to officially warn consumers about the health hazards associated with drinking soda and other sugary beverages.

Photo Credit: urbans / Shutterstock

Childhood obesity is an epidemic sweeping the United States, with 27 million kids — that’s one in every three children — overweight or obese. Research shows that the single biggest contributor to this epidemic is sugary drinks. Despite warnings by pediatricians, parents are unaware of the dangers of sugary drinks such as sodas, juice drinks and so-called sports drinks.

In January, the Baltimore City Health Department introduced innovative yet controversial legislation to the city council that seeks to require warning labels for sugary drinks at the point of sale — similar to the product warnings on cigarettes and alcohol, but not on the actual packaging itself. San Francisco attempted similar legislation but has not yet implemented it; Baltimore may become the first city in the country to enact this kind of law.

A recent Harvard University-led study shows that health warning labels on sugary drinks may help parents make better beverage choices for their children. This study helps support the effort in Baltimore and elsewhere to keep the public informed about the dangers of certain kinds of foods and ingredients in foods to protect public health.

I had a chance to ask Baltimore City Health Commissioner Leana Wen some questions about the proposed legislation and what it could mean for Baltimore as well as the beverage industry.

Reynard Loki: What is the new legislation seeking to require exactly?

Leana Wen: The law would require putting a warning label at the point of sale. We are not able to, through city legislation, put a warning label on the soda bottle itself. This is not a tax law, this is not anything that requires expenditure by the beverage companies or by stores, rather it requires that a warning sign be put up at the point of sale. At the cashier's desk, on advertisements also and on, let's say, on refrigerators where these substances are to be sold.

RL: And it’s not just about carbonated soda.

LW: You’re right, it's also sports drinks and other sugary beverages. It's things that are misleadingly labeled because, including the fact that labels often don't say sugar or sucrose, they will says HFCS, high-fructose corn syrup. It's misleading. People don't know that that is actually sugar.

RL: How did the idea for the warning labels come about and do you expect a strong challenge?

LW: Actually, the idea didn’t come from us in the health department, it came from our community partners. When it comes to soda and sugary drinks, we expect to encounter many political challenges, but we are not afraid to step up to the plate because it's what we've always done. We push the envelope and are not afraid to do the right thing — even when it's politically challenging. The fact that the idea came from our community partners is another reason why we're so committed to this: We're doing this on behalf of the community, tackling an issue that we know is very important.

RL: How did the message get to you specifically?

LW: I came to the health department just over a year ago and I did a listening tour of our key stakeholders — which included our faith groups, youth leaders, parents, neighborhood associations — and I heard over and over again that obesity is a serious public health issue here in our city; that one in three of our children are overweight or obese.

RL: So in terms of timing, from the inception of this idea to the actual introduction of legislation took only about a year. That seems quite fast.

LW: Actually, much less than that. I'll give you another example of how quickly we can move. In July, we learned from our community members that synthetic drugs are on the rise not only in the country, but especially in Baltimore. Synthetic marijuana, spice, K2, bath salts — we've had a large increase in the number of our children showing up to the ERs because they have ingested these substances. Within a month and a half we mobilized our community groups, got legislation introduced in city council, and it's just gone through third reader, and it's about to get signed by the mayor.

The idea for the soda and sugary beverage warning labels came about in the last year, but really has crystallized in the last three or four months.

RL: In terms of protecting children, have parents singled out the beverage industry as a main culprit in the obesity crisis?

LW: There are many families in Baltimore who have said they are horrified to learn that sugary drinks are so bad for health. It's become normal, a part of culture, a part of how they grew up, to serve a sugary drink with a meal every day. Now parents and neighborhood advocates are upset that there has been disproportionate marketing of sugary beverages toward communities of color and communities in low-income areas. All you see are advertisements of a sports star or a singer who is talking about sugary drinks as if it's the coolest thing in the world. But you don't see a similar warning that, actually, these sugary drinks cause obesity.

They are the single biggest contributor to obesity in our city and across the nation. They are empty calories that have no nutritional benefit at all. We've seen that the rates of obesity in our low-income communities has been increasing, especially among our children. This is a public health threat and there is a lot more that needs to be done. This campaign is really is about getting important product information out there and leveling the playing field so that we can provide our community with the information that they need to make the best decisions for their health.

RL: What is the bill’s current status?

LW: There are nine co-sponsors so far, but it has not come out of committee. It has not even been voted out of committee yet. We expect many more steps prior to the law passing.

RL: Can you describe the pushback you’ve encountered so far?

LW: We have encountered significant pushback. In fact, it's been more than I could have imagined. The American Beverage Association and other lobbying groups spend $100 million every year fighting any effort at regulation and legislation. They clearly see the work that we do in Baltimore as a threat. There are many roadblocks that they can put up between now and the passage of the law. They have already been reaching out to the same community groups that asked us for this in the first place to try to get them to switch their views. We know anecdotally that they've reached out to our legislators. We hope our legislators will stick with us despite the heavy lobbying that they're receiving. It's been a challenging time for us because these companies have a lot more resources than we do.

RL: Is there an opportunity for the beverage industry to become a public health ally rather than a public health enemy?

LW: There is always an opportunity to partner with industry. We know that in the past there have been efforts at it, including the American Heart Association partnered with the Clinton Foundation for the Alliance for Healthier Generation. That did result in a decrease in the amount of sugary drinks that got sold, in particular to children. Industry has also tried to do some self-policing when it comes to targeting advertisements to children and reducing that.

However, we also believe that it is the role of public health to serve as watchdogs for consumer groups, doctors and public health organizations to say that this is an epidemic that's affecting our population now; this is an issue that we have to take aggressive measure because this is literally killing our children.

The efforts to self-police by industry have not been effective before, they have been independent evaluations that have been done that show that, for example, despite industry claiming that they've stopped targeting children that they actually still target children and in force. Also that the number of advertisements to, again, low-income communities has only increased, especially among children there, and so you're right, there is an opportunity for industry to step up and we look forward to working with them. But I also think that there is a role for public health to be the watchdog because ultimately our job is to protect the health and well-being of our population.

RL: Has Mayor Stephanie Rawlings-Blake given any indications of her intention if the bill arrives on her desk?

LW: It's hard for us to speculate, but I will say that our mayor has been fully committed to public health efforts. She has been a staunch supporter of our many other efforts in the city that do involve taking a big risk and so we really need to see what the city council does. And there is so much that could happen between now and when it reaches her desk.

RL: A study published last month in the journal Pediatrics found that a point-of-sale warning label might deter parents from buying sugary drinks. This finding gives validity to your campaign.

LW: On the city level, I will say that we know that warning labels work and that warning labels at the point of sale also work. If you go to fast-food restaurants there are now menu labels that are posted up at the point of sale to provide consumers the information that they need to make the best decision about their health. It’s a question of empowering our community members, our patients, our clients, our residents in the city to make an informed decision about the product that they're buying. We see this for other kinds of labeling. Warning labels for sugary beverages is a good first step in the process to reduce their consumption.

RL: What other strategies has Baltimore used to cut down on sugary drink intake?

LW: That's a great question. This is a several-pronged approach. We have, and are still doing, public education, so we launched a campaign called Re-Think Your Drink. We have another campaign that's a 30-day challenge to replace your sugary drinks with something else. There are websites available where you can find what alternative drinks there are and information about how many calories, how much sugar is in the drinks that you have. Education is a key component.

Calendar created by Kelleigh Eastman.

We also have a program called Baltimarket, which includes two things. First is the Virtual Supermarket. One in three African Americans in our city lives in a food desert without access to fresh fruits and vegetables. Virtual supermarket is a way to deliver these healthy foods to individuals who are living in a food desert and also to encourage healthy food habits. The other part of Baltimarket is something called Healthy Corner Stores, in which we recognize that our retailers want to do the right thing. They want to be empowering our patients, our residents to better health and so we're working with them in a Healthy Corner Stores initiative to allow them to have healthy foods to be made available instead of foods that are dangerous like sugary drinks.

RL: Baltimore has traditionally pushed topics of public health. What are some examples showing that the city has been the nation’s urban public health vanguard?

LW: Well, for one thing, we are the oldest, continuously running health department in the country. Last year we were able to pass and implement a policy called Healthy Vending in our city properties where 50 percent of every vending machine must carry healthy foods.

Going beyond food, we were one of the first cities in the county to do a needle exchange. We've had our needle exchange programs for over 20 years and needle exchange vans have distributed the antidote medication, Naloxone, for over a decade. Last year, we launched an aggressive overdose awareness campaign that has been so successful I became the single largest prescriber of Naloxone in the United States. We do overdose response training across the city, from shooting alleys to jails, and trainings of family and friends — a lot of ways that are well beyond what other cities are able to do politically.

We also see health as being tied to everything. For example, we look at violence, including gun violence, as a public health issue. We believe that investment in early childhood is one of the most effective interventions in violence prevention. We look at programs like home visiting for pregnant moms and tie that to crime prevention later on, because it's our belief that we need to invest as far upstream as possible.

RL: You’re investing upstream; do you also envision an upstream battle for the warning label legislation?

LW: This is truly a grassroots effort that we've launched; we have very few resources for our campaign. The beverage companies are pouring in massive amounts of resources. They are disproportionately targeting our communities, which is leading to an increase in health disparities in our most vulnerable communities. From our standpoint, we’re here to do education. We're here to provide unbiased information. We hope that our community groups, and importantly, our legislators, stick with us even though we understand that they do face significant opposition. They really have to be brave in joining us and sticking up for what’s right.

RL: Being a doctor and a public health advocate, what would you tell a parent concerned that her child is drinking sugary drinks outside the home?

LW: When parents learn about how dangerous these drinks are, they stop doing it. I think the first thing is to make sure there aren't sugar drinks available in the house because it is something that is part of many different households. I think that's the first thing. The second thing is educate your children. Show them how much sugar is in a Coke or in a Pepsi or in a sugary drink. There are experiments that you can look up online, but basically you measure the number of teaspoons of sugar in a single drink and then can you see exactly how dangerous these substances are. I do think that education is important, that conversation between parent and child is important. But ultimately it starts with the parent's role modeling for their children and not having it in the house, not drinking it and certainly being aware of the dangers of these sugary drinks on the health of their children.

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