We Are Winning the Fight Against Big Soda and the Health Catastrophe It Has Created

The following is an excerpt from the new book Soda Politics: Taking on Big Soda (and Winning) by Marion Nestle (Oxford University Press, 2015): 


In December 2011, New York City mayor Michael Bloomberg announced some excellent news. After years of city interventions to improve diet and physical activity patterns, the prevalence of obesity among New York children had started to decline. With this evidence that the city’s public health measures were having the desired effect, Bloomberg appointed a task force to recommend further actions.

The task force released its report in May 2012. One of its 26 recommendations was to “establish a maximum size for sugary drinks in food service establishments.” The task force noted that “sugary drink portion sizes have exploded over recent years....Setting a maximum size for sugary drinks offered and sold in restaurants and other Food Service Establishments is a way we can change the default and help reacquaint New Yorkers with ‘human size’ portions to reduce excessive consumption of sugary drinks.”

On this basis, the mayor proposed what he—and advocates—formally named the “Sugary Drink Portion Cap Rule,” a 16-ounce limit on the size of sugary drinks that can be offered in restaurants or retail stores overseen by the city. Opponents of the measure, however, immediately called it a “soda ban,” a framing term far more likely to evoke public dismay, if not outrage. The term “ban” took hold so quickly that even city officials sometimes slipped and used it. In this chapter, I review the rationale for public health initiatives to control portion sizes, and recount the fate of New York City’s Portion Cap Rule, here abbreviated as “portion cap” or “rule.

Sodas were not always served in supersized containers. Coca-Cola’s original 1916 contour bottle contained 6.5 ounces. Pepsi, as noted earlier, introduced the 12-ounce bottle in the 1930s. As late as 1954, 61 percent of bottled sodas contained less than 7 ounces and only 8 percent were larger than 20 ounces. Coca-Cola did not introduce sizes larger than 6.5 ounces until 1955. Today’s soda bottles range from 7.5 ounces to 2 liters (64 ounces), and the standard size in vending machines is 20 ounces—three times larger than the original.

Fountain drinks followed a similar trend. In the 1950s, McDonald’s served 7-ounce drinks, but it added larger sizes throughout the 1960s and 1970s. As Lisa Young describes in her book The Portion Teller, Burger King’s sodas in the 1950s contained 12 or 16 ounces, but by the early 2000s, the chain offered 12-ounce kiddie, 16-ounce small, 22-ounce medium, 32-ounce large, and 42-ounce king sizes. McDonald’s did the same but called them child, small, medium, large, and supersize, respectively. The 6.5-ounce soda, the industry standard for decades, is roughly half the size of a portion now considered suitable for a child.

Restaurants and fast-food chains also encourage large portions. Customers like bargains, have come to expect large containers, and in places like Texas complain when they are not available. Most of all, large sodas are wonderfully profitable for their makers and sellers.

THE SODA “BAN”: ABA-ORGANIZED OPPOSITION

The American Beverage Association mounted an enormous public relations campaign to convince New Yorkers that the “ban” on large soda sizes infringed on freedom of choice. It began by attacking the science in a full-page ad in the New York Times (June 1, 2012): “Are soda and sugarsweetened beverages driving obesity? Not according to the facts.” The ABA explained: “The facts make it clear—beverage calories and added sugars have decreased for more than a decade, while the CDC reports obesity rates continue to climb.” The ad did not mention the overall leveling off of obesity in parallel with the decline in soda sales.

The ABA and its allies complained that the ban was a “nanny-state” move that would force people to sneak off to drink large sodas in secret, as Figure 25.3 suggests. Even the New York Times misinterpreted the cap as a ban: “Mr. Bloomberg, however, is overreaching with his new plan. . . .The administration should be focusing its energies on programs that educate and encourage people to make sound choices. . . .[T]oo much nannying with a ban might well cause people to tune out.” The soda and restaurant industries bought help from the Center for Consumer Freedom (CCF). Its full-page advertisement, shown in Figure 25.4, depicted Mayor Bloomberg wearing a dowdy blue dress: “The Nanny. You only thought you lived in the land of the free. Nanny Bloomberg has taken his strange obsession with what you eat one step further. . . .New Yorkers need a mayor, not a nanny.” Bloomberg, fortunately, has a sense of humor: when asked about the ad at a press conference, he said, “Would I wear a dress like that? No! It was one of the more unflattering dresses."

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Figure 25.4 The infamous “Bloomberg nanny” ad, New York Times, June 2, 2012. The ad was placed by the Center for Consumer Freedom, the industry-funded public relations firm discussed in the previous chapter. “Bye Bye Venti. Nanny Bloomberg has taken his strange obsession with what you eat one step further. He now wants to make it illegal to serve “sugary drinks” bigger than 16 oz. What’s next? Limits on the width of a pizza slice, size of a hamburger or amount of cream cheese on your bagel?”

The CCF does not reveal its funding sources, but both Coca-Cola and the National Restaurant Association have been identified as clients. The Restaurant Association’s interest is easily explained. According to Advertising Age, soft drinks account for about 10 percent of sales in fast-food and casual restaurants, and come with a profit margin of 90 percent.

The ABA created a new astroturf organization, Let’s Clear It Up, and a website to “clarify myths” and give the industry’s spin on the science of sodas and health. Coca-Cola used a different strategy: divert attention from sugars and calories. Its New York Times advertisement on June 10 said, “Everything in moderation. Except fun, try to have lots of that... By promoting balanced diets and active lifestyles, we can make a positive difference.”

Coca-Cola’s president of sparkling beverages in North America, Katie Bayne, explained the company’s opposition to the cap rule to a reporter from USA Today:

Q: Is there any merit to limits being placed on the size of sugary drinks folks can buy?

A: Sugary drinks can be a part of any diet as long as your calories in balance with the calories out. Our responsibility is to provide drink in all the sizes that consumers might need.…

Q: But critics call soft drinks “empty” calories.

A: A calorie is a calorie. What our drinks offer is hydration. That’s essential to the human body. We offer great taste and benefits whether it’s an uplift or carbohydrates or energy. We don’t believe in empty calories. We believe in hydration.

The campaign against the cap rule appeared to be well orchestrated and lavishly funded, and it consistently invoked nanny states, intrusion on personal choice, and lack of patriotism. Groups of young people gathered at farmers’ markets and other crowded places to collect signatures on petitions to block the cap. Paid $30 an hour (or so they said) by another ABA-sponsored front group, New Yorkers for Beverage Choice, they wore T-shirts saying “I picked out my beverage all by myself ” and handed out cards: “Don’t let bureaucrats tell you what size beverage to buy.” Soda delivery trucks were emblazoned with such slogans (Figure 25.5). Ads appeared on television, in movie theaters, and on airplane banners. As a resident of New York City, I received a home mailing from the ABA with instructions on how to protest the “ban."

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Figure 25.5 Coca-Cola delivery truck, New York City, 2012. During the debates about the portion cap, Pepsi and Coca-Cola delivery trucks carried signs telling customers, “Don’t let bureaucrats tell you what size beverage to buy.” The signs remained on the trucks well into 2014. Photo courtesy of Daniel Bowman Simon.

It is impossible to know how much of the protest was spontaneous, as opposed to deliberately organized by the soda and restaurant industries, but the website of New Yorkers for Beverage Choice revealed that it was maintained by Goddard Clausen, the public relations firm recruited by the ABA to defeat soda tax initiatives. It is also difficult to know the extent to which these industries were behind federal and state initiatives to block similar attempts. Senator Ted Cruz (R-Tex.), for example, introduced an amendment to the congressional budget resolution intended to prevent federal regulation of the size of foods and beverages. The amendment failed to pass. But Mississippi, where nearly 35 percent of the population is obese and overall health ranks last among the fifty states, passed a bill preventing local communities from setting limits on soda size as well as on salt content, toys in fast-food children’s meals, calorie counts on menus, and genetically modified foods. By 2014, such bills had been introduced in at least eight other states.

I wish I could tell you how much money the soda industry spent to defeat the cap rule, but this was not an election and expenditures did not have to be disclosed. The amounts must have run into the millions in advertising, home mailings, payment of astroturf “volunteers,” and the not inconsiderable costs of the subsequent legal challenges.

***

In her opening address to the Eighth Global Conference on Health Promotion in 2013, Dr. Margaret Chan, director-general of the World Health Organization, concluded with a statement that touches on many of the themes of this book:

"Efforts to prevent noncommunicable diseases go against the business interests of powerful economic operators. . .it is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. . .front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt. . . gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public. They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice. . . . Few governments prioritize health over big business. As we learned from experience with the tobacco industry, a powerful corporation can sell the public just about anything."

“Just about anything,” in this context, means sugar-sweetened beverages— calorically empty, demonstrably unhealthful, environmentally polluting, and extravagantly marketed. Figure 28.1 illustrates some of these points.

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Figure 28.1 How soft-drink pushers think. Joel Pett suggests that the drive for corporate profit causes Big Soda to engage in marketing and lobbying efforts that pump kids full of junk and trash the environment. Such methods are no different from those used by Big Food, Big Alcohol, or Big Tobacco. Joel Pett editorial cartoon, with permission of Joel Pett and the Cartoonist Group. All rights reserved.

Dr. Chan continued by reminding the audience that no country to date has been able to reverse obesity. This, she said, is “not a failure of individual will-power. This is a failure of political will to take on big business. . . .When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely.” The influence of industry on health policy, she added, is “well documented, and dangerous,” so much so that “in the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests.”

Her point is that the marketing strategies of Big Soda, Big Food and Big Alcohol are much the same as those of Big Tobacco. Their profit goals are similar and conflict with those of public health. Singly and together, Big Food and Big Soda promote obesity and type 2 diabetes, a condition now understood to be a public health problem as prevalent and costly as those caused by alcohol and tobacco. 

In her speech, Dr. Chan did not suggest steps that governments must take to protect their health policies against corporate interests, nor did she say what advocates could do to encourage governments to take such steps. Others, however, have done so, drawing especially on parallels with Big Tobacco. In this concluding chapter, I review some of the more prominent campaigns to limit the actions and impact of Big Soda, introduce several additional advocacy approaches currently under consideration, and summarize the principal strategies needed for effective advocacy for any intervention aimed at promoting healthier food choices.

Let me acknowledge immediately that advocacy to reduce soda intake faces special challenges that distinguish it from advocacy for reduction of alcohol, tobacco, or junk foods. Like these other industries, the soda industry sells relatively inexpensive products that are available in almost every corner of the globe. Like them, this industry is extremely wealthy. Also like the others, health is the industry’s Achilles’ heel. But in sharp contrast to companies selling junk food, alcohol, or tobacco, Coca-Cola and PepsiCo consistently rank among the most admired, respected, and honored companies in the world. Health and environmental advocates must recognize the power of this favorable public perception when encouraging others to resist it.

ADVOCACY IS WINNING

In 2014, I attended CSPI’s Soda Summit in Washington, D.C., a meeting that brought together hundreds of advocates engaged in a variety of projects to reduce soda consumption. One speaker after another began with what seemed like the meeting’s overriding theme: “We are winning.” Sales of sugar-sweetened sodas have been falling steadily in the United States for a decade, with no sign of reversal. And sales are falling faster in places with active “drink less soda” campaigns. In Great Britain, where 60 percent of drinks already contain no sugar, sales of sports drinks are also falling as public health campaigns such as Give Up Loving Pop (GULP) are having an effect. In 2015, the French parliament banned unlimited refills of soft drinks. Drink preferences are changing to the healthier—or to the perceived healthier—and not just as a result of economic recession or changing food prices. By far the most convincing explanation for this downward trend is the public’s response to health advocacy.

To the dismay of soda companies, diet drinks have also become the subject of health concerns, and their sales too are falling rapidly. In 2015, in an attempt to reverse this trend, Pepsi announced that it would no longer use aspartame to sweeten these drinks. Because customers singled out aspartame as the main reason why they stopped drinking Diet Pepsi, the company said it would replace aspartame with artificial sweeteners perceived as less harmful. But if these perceptions change, diet soda could be at even greater risk.

Without question, advocacy has gained media attention, increased public awareness of the health effects of sodas, and engaged communities and young people. Nearly two-thirds of Americans now say they are avoiding sodas in their diet—an increase of 20 percent since 2002. It is no coincidence that along with the decline in consumption of sugary drinks, the prevalence of obesity is leveling off and even declining in some groups.

Soda companies are responding to this “failure and disarray” in their business by lowering their revenue and growth targets, and by diversifying their product portfolios in ways that were unimaginable just a few years ago. In 2014, Coca-Cola paid more than $2 billion to acquire a significant stake in Monster Beverage, the maker of highly caffeinated energy drinks recently associated with the deaths of several young people. It also invested in Fairlife, a milk filtered and treated with lactase (the enzyme that splits lactose, the sugar in milk that some people cannot digest, into glucose and galactose) to produce a milk product with 50 percent more protein and 30 percent less sugar. This product will cost twice as much as regular milk, but the company expects it to “rain money."

Also in 2014, in a move widely viewed as an admission that sugary drinks promote obesity, the Alliance for a Healthier Generation (founded by the American Heart Association and the Clinton Foundation) and the American Beverage Association (funded mainly by Coca-Cola and PepsiCo) jointly pledged to reduce the calories in such drinks by 20 percent by 2025. Although Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, was “especially pleased that this commitment will target communities with disproportionately high consumption rates of sugar-sweetened beverages,” the move appeared more as public relations than as a genuine commitment to health. The industry was still pouring millions into fighting soda tax initiatives and warning labels and into promoting its products in African American and Hispanic American communities.

Business analysts worry about the soda industry’s response to health concerns. They think soda companies should be working harder to reduce the impact of their products on health and the environment. They are well aware that this industry is vulnerable to attacks by competitors such as Brita, the maker of devices that filter tap water; this company advertised its filters by displaying the number of sugar cubes soda drinkers consume in a year. The Wall Street Journal produced a video highly critical of Coca-Cola’s seemingly desperate marketing response to declining sales. Bloomberg BusinessWeek displayed similar views.

Business analysts also want soda companies to clean up some of their more unsustainable management practices. The billionaire Warren Buffett, a major investor in Coca-Cola, thinks the company’s executives are paid too much. So does Calvert Investments, which notes that the compensation paid to Coke’s CEO is “not well aligned with sustainable shareholder interests.” Coca-Cola, Calvert says, should modernize its board of directors to deal with its members’ age, entrenchment, and lack of independence, so as better to “address sustainability challenges and opportunities,” especially in emerging markets. Another group, Wintergreen Advisers, runs a website (fixbigsoda.com) devoted to getting better value from the 2.5 million shares of Coca-Cola it manages for its clients. In 2015, the Gates Foundation liquidated its holdings in Coca-Cola, valued at $914 million, along with holdings in McDonald’s and ExxonMobil. Analysts interpreted these actions as consistent with the foundation’s policy not to invest in companies whose corporate activities it finds to be “egregious.”

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Figure 28.5 Bloomberg BusinessWeek, August 4–10, 2014. The cover story focused on the threat posed by obesity to Coca-Cola’s sales and profits. The magazine took a dim view of Coca-Cola’s announcement that it would be concentrating its marketing efforts on smaller cans and bottles. Used with permission of Bloomberg L.P. Copyright© 2014. All rights reserved.

But before celebrating, consider the work that still needs to be done. Soda companies are marketing sugary juice drinks, teas, coffees, waters, and sports drinks as healthier options. They have shifted their soda marketing to target the low-income populations of the developing world, particularly in Asia, Latin America, and Africa. These actions demand further advocacy. The actions of advocates for reduced soda intake may be less advanced in emerging markets, but they are increasing in scope and intensity as international governments confront the personal and economic costs of obesity and type 2 diabetes in their countries. The Mexican government’s banning of soda and junk food advertisements on daytime television in 2014 may well signal the beginning of major international efforts to counter soda marketing.

Also relevant is increasing public support for a new kind of corporate structure—benefit corporations—that link profit mandates to production of measurable societal benefits. By 2014, nearly half the states authorized such structures for incorporation of new businesses. These states require corporate directors to consider the interests of all stakeholders, not just owners of shares, when making business decisions. Although it is unlikely that either Coca-Cola or PepsiCo will switch to this model, benefit corporations put pressure on other businesses to make their corporate social responsibility actions more genuinely socially responsible.

***

Like businesses in general, food businesses—even the most socially conscious—must put profits first. To be effective, advocates must understand that soda and other food corporations are willing to spend fortunes to influence political processes. Without anywhere near that kind of funding, it becomes necessary to find smarter methods for using the political process to counter soda industry marketing. At the very least, advocates should hold legislators and food companies accountable when they fail to support— or actively oppose—public health and environmental measures. Enormous opportunities are available for advocacy work to counter pressures on corporations to grow at any cost, to push back on relentless marketing and lobbying, and to educate the public about the need to create systems and environments that support healthier food choices. My hope is that my new book, Soda Politics provides compelling evidence for the value of food advocacy work. I wrote it to inspire readers to action. Join the food movement. Work with others to make adequate, safe, accessible, affordable, healthy, and delicious food available for everyone, everywhere.

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