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June 17, 2013 10:40 AM The Big Soda Ban Is Dumb

By Aaron Carroll

Several readers sent me the following study at the end of last week. “Caloric effect of a 16-ounce (473-mL) portion-size cap on sugar-sweetened beverages served in restaurants“:

Background: New York City recently proposed a restriction to cap the portion size of all sugar-sweetened beverages (SSBs) sold in food-service establishments at 16 oz (473 mL). One critical question is whether such a policy may disproportionally affect low-income or overweight individuals.

Objective: The objective was to determine the demographic characteristics of US individuals potentially affected by a 16-oz portion-size cap on SSBs and the potential effect on caloric intake.

Design: We analyzed dietary records from the NHANES 2007-2010. We estimated the proportion of individuals who consumed at least one SSB >16 fluid oz (473 mL) in restaurants by age, household income, and weight status.

Results: Of all SSBs >16 oz (473 mL) purchased from food-service establishments, 64.7% were purchased from fast food restaurants, 28.2% from other restaurants, and 4.6% from sports, recreation, and entertainment facilities. On a given day, the policy would affect 7.2% of children and 7.6% of adults. Overweight individuals are more likely to consume these beverages, whereas there was no significant difference between income groups. If 80% of affected consumers choose a 16-oz (473-mL) beverage, the policy would result in a change of −57.6 kcal in each affected consumer aged 2-19 y (95% CI: −65.0, −50.1) and −62.6 kcal in those aged ≥20 y (95% CI: −67.9, −57.4).

Conclusion: A policy to cap portion size is likely to result in a modest reduction in excess calories from SSBs, especially among young adults and children who are overweight.

This was a retrospective study comparing those who drank at least one 16 oz or greater sugar sweetened beverage per day to those who did not. The results aren’t surprising. Most of the beverages were purchased from fast food restaurants. And, more than 7% of adults and children partook of at least one such beverage each day. Moreover, the study found that if a policy banning such beverages were enacted, and people decided to abandon these large beverages, they’d consume about 60 less calories per day.

I don’t doubt any of this. But it all misses the point. It’s the policy that I doubt, not the beverages. I’m concerned that the policy won’t result in what the researchers hope will happen. In fact, simulations show things could get worse. There’s lots of evidence that it’s more than just the sugar sweetened beverages that’s the problem. Plus, this:

How does it make sense to ban a 225-calorie soda when a “Gotta Have It”-sized PB&C (peanut butter and chocolate ice cream) shake at Cold Stone Creamery clocks in at 2010 calories alone? That drink got the top prize in the 2011 Xtreme Eating Awards sponsored by the Center for Science in the Public Interest. Or perhaps you could wander over to the Cheesecake Factory and get yourself a Farmhouse Cheeseburger (for 1530 calories) and a nice piece of Ultimate Red Velvet Cake Cheesecake (for an additional 1540 calories). Without even touching a French fry, you’ve consumed more than 3000 calories.

Fancier food isn’t immune either. A Morton’s steakhouse Porterhouse with mashed potatoes and half a side of creamed spinach rates 2570 calories, 85 g of saturated fat, and 2980 mg of sodium. As the CSPI noted, “That’s the calories of eight pieces of Original Recipe chicken plus mashed potatoes and gravy, coleslaw, and four biscuits at KFC [Kentucky Fried Chicken], with an extra 1½ days’ [saturated] fat on the side.”

I’m sorry, but banning the soda and leaving the rest untouched is silly to me. It’s a distraction. I’m all for trying to get people to reduce their caloric intake. I don’t think another study showing us that some of those calories come from sugar sweetened beverages convinces me that a ban on this one thing is worthwhile.

[Originally posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Childrens Health Services Research at Indiana University School of Medicine.
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