By the year 2030, half of all Americans will be obese, according to a Robert Wood Johnson Foundation study. Obesity related healthcare costs would increase by as much as $66 billion per year. In an effort to combat the obesity epidemic, Mayor Michael Bloomberg proposed a ban on the sale of sweetened drinks larger than 16 ounces. Unless blocked by a judge, it’s slated to go into effect on March 12.  

Critics rightly point out that the policy has flaws that may limit its effectiveness. For example, the restrictions focus on restaurants and movie theaters, but there’s no limitation on serving sizes for 7-Elevens and corner grocery stores. Furthermore, many fast food restaurants have self-serve soda machines, so there’s nothing to prevent a patron from buying a 16-ounce cup and going back for refills. But New York Health Commissioner, Thomas Farley counters, "shrinking only one sugary drink per person every two weeks from 20 ounces to 16 ounces, New Yorkers could collectively prevent 2.3 million pounds gained per year. This would slow the obesity epidemic and prevent much needless illness." His argument is bolstered by two new studies reported in The New England Journal of Medicine showing that avoiding sugary beverages limits weight gain.

Most of the critics don’t focus on the practical limitations of the policy but rather they object to the government attempting to control what we eat and drink. It’s suggested that this is the beginning of the “nanny state,” with government intruding in personal decision-making. Why stop with soda? Should doughnuts be banned? How many strips of bacon would be allowed in restaurant breakfasts?

I would suggest that the lessons from our four-decade experience with tobacco control should be applied to efforts to reduce obesity. Before the Surgeon General’s Report in 1964, smoking was a matter of individual choice. I remember a representative of one of the tobacco companies sitting in the dorm lobby when I was an undergraduate handing out free sample packs of cigarettes. On a flight from New York to Washington I had to insist on being seated in the non-smoking section of the plane, but still smelled second-hand smoke. After the Surgeon General’s Report, smoking became a public health issue with increasing governmental interventions in decisions that had been considered purely personal. Now 19 percent of the population smokes compared with 42 percent before, and few people would advocate going back to pre-1964 policies.

If we can accept government intrusion in smoking choices, why is there backlash against government involvement in food choice? I suspect two forces are operating. First, there is a single behavior that is the target of anti-tobacco interventions: stop smoking. The goal of any obesity prevention program is less clear-cut. There are more variables contributing to weight gain and no one is advocating that we stop eating. Even if sodas were completely eliminated we’d still have an obesity problem. I would suggest that there are interventions that can be helpful even if no single one provides a complete solution. Airbags don’t prevent all driving fatalities, but they are still useful.

A second, more subtle factor is the emotional significance of feeding our children and ourselves. From breastfeeding in infancy to birthday cakes in childhood and Valentine's Day chocolate in adulthood, eating and being fed has emotional connotations. As parents, feeding our children is one way we nurture and love them. Although there are objections to fluoridation, seat belt laws and other “nanny state” interventions, they don’t feel as intrusive because they don’t trigger the emotions associated with eating.

Overcoming the emotional barriers to obesity prevention policies won’t be easy, especially with the food and restaurant industry lobbies using the “nanny state” argument to preserve the status quo. Ever since Mayor Bloomberg proposed the policy it has been the subject of numerous articles, TV stories, and online discussions (2.3 million on Google). Regardless of the effectiveness or lack of effectiveness of the 16-ounce limitation, Mayor Bloomberg is to be applauded for increasing awareness of the problem and suggesting that government interventions are needed to address this looming public health disaster.

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