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Life is Sweeter Summit TAF presentation 6 4 12-Final _2010_-PDF

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					From Supersized to Human-Sized:
   Reintroducing Reasonable
   Portions of Sugary Drinks
        in New York City
                    Adult Obesity and Smoking Prevalence
                                       New York City, 2002-2010

               24                                                                                          23.3   23.4
                                                                                                    22.6
                                                                                            22.1
                                                21.7
               22                                                            21.1
                    21.5         20.1                         19.9
 % of adults




               20
                      18.2
                                 19.2                         18.9
               18
                                                18.3
                                                                             17.5
               16                                                                           16.9
                              Smoking %
                                                                                                    15.8   15.8
               14             Obesity %
                                                                                                                  14.0
               12




Source: New York City Department of Health and Mental Hygiene. Community Health Survey 2002-2010.
                     Measuring the Crisis of
                   Obesity and Diabetes in NYC
• Obesity
     – Estimated 5,800 deaths/yr, of which 2,000 under age 70 1
     – ~$4 billion in direct medical costs
• Diabetes
   – 1 in 8 adult New Yorkers has diabetes
   – 1 in 4 has pre-diabetes
   – 2,600 hospitalizations for amputations annually
   – 1,400 new cases of diabetes-linked end-stage renal
     disease requiring dialysis each year
              • medical costs for dialysis ~$80,000 per person/per year
     – >100,000 adults 40 years and older have retinopathy

 1. New York City Department of Health and Mental Hygiene. Preventing Non-Communicable Diseases and Injuries: Innovative Solutions from New York City.
 New York: New York City Department of Health and Mental Hygiene, 2011.http://www.nyc.gov/html/doh/downloads/pdf/ip/un-rpt.pdf
             Sugary Drinks and the Obesity Epidemic
   • Americans consume 200-300 more calories per day than 30
     years ago, with the largest single increase due to sugary
     drinks. 1
   • Sugary drinks contain enough calories that daily additional
     intake of 12-oz serving could increase weight by 15 pounds a
     year. 2
   • Observational studies show an association between long-
     term sugary drink consumption and obesity or weight gain
           – Each additional 12 oz. soft drink consumed per day by children increases
             their odds of becoming obese by 60%. 3
   • Randomized controlled trials show that decreasing sugary
     drink consumption reduces weight or weight gain
           – Students who reduced their sugar-sweetened beverage consumption had
             7.7% lower incidence of overweight. 4

1. Finkelstein EA, et al. Ann Rev Pub Health. 2005; 26:239-257; 2. Malik VS, Schulze MB, Hu FB. Am J Clin Nutr. 2006;84:274-288; 3. Ludwig DS, Peterson KE,
Gortmaker SL.. Lancet. 2001 Feb 17;357(9255):505-8; 4. James J, Thomas P, et al. BMJ 2004;328:1237.
                    Sugary Drink Consumption is Strongly Correlated
                          with Obesity in NYC Neighborhoods
                    45.0


                    40.0         Bronx=
                                 Brooklyn=
                    35.0         Manhattan=
                                 Queens=
                                 Staten Island=
   % adults obese




                    30.0

                             R² = 0.5769
                    25.0


                    20.0


                    15.0


                    10.0


                     5.0


                     0.0
                           0.0        5.0         10.0   15.0    20.0     25.0     30.0    35.0       40.0    45.0          50.0


                                                          % adults drinking 1+ sugary drink per day

Source: NYC Community Health Survey, 2010. SSB (Sugar-sweetened beverage) includes soda and other sugar sweetened drinks.
Obesity defined as Body Mass Index >=30.
                                     Portion Size Drives Consumption

        • People given larger portions simply eat or drink more

                  – People given larger portion sizes of food eat ~20-50%
                    more, without reducing intake at subsequent meals1

                  – People eating soup from self-refilling bowls ate 73% more2

                  – People given beverages 50% larger consume 20% (women)
                    to 33% more (men), with no decrease in food eaten3




1. Ledikwe JH, Ello-Martin JA, Rolls BJ. Portion sizes and the obesity epidemic. J Nutr 2005;135:905. 2. Wansink B, Painter JE, North J, Bottomless bowls: why visual cues of portion size may
influence intake. Obes Res, 2005.;13(1): p. 93-100. 3. Rolls BJ, Roe LS, Meengs JS, The effect of large portion sizes on energy intake is sustained for 11 days. Obesity 2007;15:1535.
   Bottle Sizes Have Increased




Original 1920s     12 ounce cans   20 ounce contour    1 liter (34 oz) contour
size: 6.5 ounces   introduced in   bottles             bottles introduced in
                   the 1960s       introduced in the   late 1990s
                                   early 1990s
     16 ounces of Coke used to be enough for 3 people!




Source: The World of Coca Cola, Atlanta Georgia 2011.
                             Fountain Drinks are Huge




7 ounces             12 ounces             16 ounces             32 ounces      64 ounces
82 calories          140 calories          180 calories          374 calories   780 calories
22g sugar            38 g sugar            49 g sugar            102g sugar     217g sugar

Note: values based on fountain Pepsi-Cola product; using 2.5g sugar cubes
                                                     Exploding Beverage Sizes:
                              McDonald’s Drinks Have Grown 457% Since 1955

                     45
                                  One Size                                                                                   42                 42

                     40           Child                                                                                                                   Super-size discontinued
                                                                                                                                                            except for special
                                  Small                                                                                                                         promotions
                     35
                                  Medium                                                                  32            32                 32                    32               32
                                  Large
                     30
                                  Super Size
     Size (ounces)




                     25
                                                                                   21                21                                                                          21
                     20
                                                                16                                                                                                          16
                     15        Only size
                              available!!       12                                                                                                                        12

                     10
                          7

                     5


                     0
                              1955           1961         1962               1974               1988               1999                2003               2004               2010

1. Young L. The Portion Teller Plan: The No-Diet Reality Guide to Eating, Cheating, and Losing Weight Permanently. New York: Morgan Road Books, 2005. Print ; McDonald’s Website, retrieved
November 10, 2010: http://nutrition.mcdonalds.com/getnutrition/nutritionfacts.pdf
            Supersizing Doesn’t Have to be the Norm
        Portions are Smaller in Other Countries
  Calories in McDonald’s Coke, by Drink Size, Selected Countries

350
                                               Largest available equivalent to a
                                              Medium (around 21 ounces) in the
300
                                                        United States

250



200                                                                                 Child
                                                                                    Small

150                                                                                 Medium
                                                                                    Large

100



 50



  0
             USA                    Italy                   UK          Australia
                         Calls on Industry to Act

• “And no matter what you do, it’s important, truly important, to
  keep portion sizes in check, because we all know that the size of a
  meal is just as important as the ingredients it’s made of.” Michelle
   Obama at the National Restaurant Association Meeting (2010, Let’s Move! Campaign)


• “Adopt approaches to support portion-size reduction and/or curtail
  emphasis on “bigger means better” messages.”
   Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and
   Obesity Report (2006, The Keystone Center)


• “Encourage the food industry to provide reasonable food and
  beverage portion sizes.”
   Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity Report (2001, US
   Department of Health and Human Services)



                      …But Sugary Drink Portions Remain Huge
                             Proposed Health Code Amendment to
                                 Reduce Beverage Portion Sizes
          • Maximum size of sugary drinks1 16 ounces at Food Service
            Establishments
                    – Applies to drinks served in restaurant cups2 and manufacturer-packaged
                      products
                    – Applies to soda, sports drinks, “energy” drinks, sweetened teas and
                      coffees, sweetened “fruit drinks”, “vitamin water” if >25 calories/8 oz
                    – Excludes diet beverages, unsweetened coffee and teas, alcoholic
                      beverages, dairy drinks (>50% dairy), >70% fruit & vegetable juice
                      without added sweetener
          • Maximum size of self-service cups3 16 ounces at Food
            Service Establishments
                    – Limit would apply to all beverages for enforcement
          • Customers who want more than 16 ounces can purchase
            more than one portion
1. A “sugary drink” is defined as: a carbonated or non-carbonated beverage that is sweetened with sugar or another caloric sweetener and has ≥25 calories per 8 oz. 2. A “restaurant cup” is
defined as: a cup that is filled with a beverage by the Food Service Establishment. 3. A “self-service” cup is defined as: a cup provided by a Food Service Establishment that is filled with a
beverage by the customer.
    Where Would Rule Apply?
• Food-service establishments in NYC
  – 24,000
  – Chains (QSR, table service), independents
  – Snack bars at movie theaters and stadiums
• Mobile food vendors in NYC
  – 5,000
Responding to Claims of Beverage Industry
• Sugary drinks make up only 7% of diet
      – That’s 140 calories a day. If added to diet, 15 pound weight gain
• Sugar from soda has declined 39% since 2000
      – Sugary drink consumption is still far higher than it was in the
        1970s, when the obesity epidemic began to surge1
• 24% reduction in average calories per serving
      – Total calories matter, not average calories per serving.
        Americans still consume about 140 calories per capita per day
        from sugary drinks1
• Food is #1 source of added sugars in American diet
      – Sugary drinks responsible for >40% of added sugars and more
        than any single food. 1,2

 1. Nielsen SJ, Siega-Riz AM, Popkin BM, Obesity Res 2002;10:370-378 ; Nielsen SJ, Popkin BM Am J Prev Med 2004;27:205-210; Welsh JA, Sharma AJ, Grellinger L,
 Vos, MB, Am J Clin Nutr 2011;94:726–34
 2.Guthrie JF, Morton JF. JADA 2000; 100:43-51.; CDC. NCHS Data Brief No. 87 March 2012.
Responding to Claims of Beverage Industry
• The obesity epidemic cannot be reversed by
  reducing sugary drink consumption
   – Nutrition experts from 4 leading institutions conclude that
     reducing sugary drink consumption is important to preventing
     obesity1
   – If we could reduce obesity by 10%, it would save ~500 lives a
     year in New York City
• Government is overreaching
   – That’s what they said when we banned lead in paint, smoking in
     bars, and trans fat in restaurants, and when we required calorie
     labeling.
   – Government has a duty to respond to a crisis

 1.Malik VS, Popkin BM, Bray GA, Despres J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and
 cardiovascular disease risk. Circulation 2010;121(11):1356-64.

				
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