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Removing sodas for sale at UCSF helps cut sugar consumption and improve health
A study of the first University of California campus (UC San Francisco) to ban the sale of soda on campus has shown that employees reduced their consumption by nearly 50 percent. UCSF staff who took part in the study also reduced their waist measurements and weight.
“This was not a ban on the consumption of sugared beverages,” emphasized co-lead author Laura Schmidt, PhD, MSW, MPH, UCSF professor in the Philip R. Lee Institute for Health Policy Studies. “This was a ban on sales on sugary beverages in vending machines, break rooms and cafeterias...People could still bring them from home or buy them off campus.”
The study was published Oct. 28, 2019, in the Journal of the American Medical Association, Internal Medicine.
California Assembly Member Richard Bloom (D–Santa Monica) noted the importance of workplace and governmental restrictions on soda sales while communities are prohibited from establishing local soda taxes for the next 12 years. In June 2018, the beverage industry strong-armed the California Legislature and Governor into enacting a “preemption” law that prohibits communities from passing local soda taxes.
“Workplace restrictions enable communities to take charge of their own health as we build momentum to pass AB 138, my bill that establishes a statewide soda tax that will fund prevention efforts. The bill will reduce soda consumption and generate positive health outcomes in impacted communities, where most needed, just like the UCSF effort,” Bloom said.
Lorrene Ritchie, UC Cooperative Extension specialist and director of the UC Nutrition Policy Institute, which conducts nutrition research to strengthen public policy, commented: “I am so impressed with both UCSF's sales ban and this very well-done study. Sodas are such a huge contributor to our obesity crisis that it is heartening to recognize a solution that any employer can adopt to help people improve their lives.”
Speaking of the UCSF study, lead author Elissa Epel, PhD, UCSF professor of psychiatry and director of the UCSF Aging, Metabolism, and Emotions Center, said: “This shows us that simply ending sales of sugary drinks in the workplace can have a meaningful effect on improving health in less than one year. There is a well-known pathway from soda to disease. High sugar intake leads to abdominal fat and insulin resistance, which are known risk factors for diabetes, heart disease, cancer and even dementia. Recent studies have also linked sugar intake to early mortality.”
Soda tax advocates ride a political roller-coaster
When Genoveva Islas was 12 years old, she was responsible for giving insulin injections to her diabetic tia, her aunt.
“Tia lost her toes, lost her leg, lost her life,” Islas said. “This is a very important fight.”
Islas is director of Cultiva La Salud in Fresno, which works to address poor nutrition and physical inactivity in the San Joaquin Valley. The fight Islas referred to is the “soda wars,” a battle to reduce the amount of sugar-sweetened beverages (SSBs) consumed by Americans. SSBs are the single most significant source of sugar in Americans' diets, amounting to nearly half of sugar intake. They have been unequivocally linked to increases in obesity, diabetes, heart disease, liver disease, tooth decay and some cancers.
Islas talked about the tragic fate of her tia at the July 2019 California Obesity Conference in Anaheim, where 1,025 public health, nutrition, science and political leaders convened to share strategies for overcoming the childhood obesity crisis in the United States. She was part of a panel on taxing sugary drinks to reduce SSB consumption and fund community health programs.
“I'm here because I believe health is a right, not a luxury,” Islas said. “A soda tax is a fight for the community I love.”
“I say regressive is the incidence of diabetes in my community, the incidence of heart disease in my community,” Islas said. “The California Central Valley has the highest rates of drinking water violations. Bottled water is costly. People are choosing sugar-sweetened beverages when it is the most affordable choice for them.”
Money raised by the soda tax, Islas continued, could support water quality improvements and encourage the public to drink free and safe tap water.
California Assemblymember Richard Bloom (D-Santa Monica), who has proposed soda tax legislation several times, was also on the soda tax panel.
“The soda industry has poured a huge amount of money toward lobbying in Sacramento against soda restriction laws,” he said.
Bloom suggested that soda tax proponents be clear about the implications of childhood obesity and associated diseases when working to implement soda tax laws.
“Words like ‘epidemic' and ‘crisis' are used so much, they start to lose their meaning,” Bloom said. “We have a lot of statistics on the science of sugary drinks, but we don't talk about the misery this visits upon people and families and communities – amputations, heart disease, cancer. We need to start telling those stories viscerally.”
Kenneth Hecht, director of policy at UC's Nutrition Policy Institute, moderated the panel discussion. He said that a soda tax is the most cost-effective intervention to reduce soda consumption. It has been implemented and studied in Berkeley, Calif., where voters in 2014 passed a local initiative to tax soda and other sugar-sweetened beverages 2 cents per ounce. Three years later, residents reported drinking 52 percent fewer servings of sugary drinks than they did before the tax was imposed.
“Soda taxes work,” said Kristine Madsen, director of the Berkeley Food Institute and professor at UC Berkeley School of Public Health, who evaluated the Berkeley soda tax and also spoke at the conference.
The bulk of Berkeley's soda tax revenue is dedicated to supporting nutrition education and gardening programs in schools and allocated to local organizations working to encourage healthier behaviors in Berkeley.
San Francisco, Oakland and Albany also passed soda taxes. Other communities were planning to put soda tax initiatives on the ballot, but were stymied by a preemptive strike waged by the soda industry. In June 2018, the California Legislature passed a bill to preempt any new local beverage or food taxes until 2031. According to Assemblymember Bloom, beverage companies spent millions to get an initiative on the ballot that would have prevented local communities from raising taxes without a two-thirds vote, up from 55% of the vote currently needed. They offered to drop the initiative if the California Legislature would impose a moratorium on local soda taxes.
Bloom called the preemption a “disgusting tactic.”
“We had to capitulate to that to protect our local governments,” Bloom said. “It was never a sprint to address soda tax, but now it's become a marathon.”
Public health activists were also outraged.
“If you have enough money, you can put anything on the ballot and use that to extort lawmakers to get what you want,” said Mark Pertschuk, director of Grassroots Change and a conference speaker. “This is a war on local democracy. We need to educate people on what preemption is.”
“It's the same as being tobacco free and drug free,” he said.
One public organization leading the way is UC San Francisco (UCSF), which employs 22,000 staff, academics and medical professionals. In 2015, all its campuses and buildings removed sugar-sweetened beverages from food service outlets and vending machines as part of its Healthy Beverage Initiative. Laura Schmidt, professor in the Institute for Health Policy Studies at UCSF, discussed the ban at the Childhood Obesity Conference.
“When you live in a saturated environment, where it's always in reach, that makes it difficult to say no,” Schmidt said. “We have to change the environment. All effective solutions follow the iron law of public health. If you reduce availability of harmful substances in the environment, you will reduce consumption.”
At the culmination of his Childhood Obesity Conference talk, Bloom announced the recent formation of Californians for Less Soda, a new coalition of public health and health equity advocates and health professionals aligned to decrease consumption of sugar-sweetened beverages in California through effective policies.
Berkeley soda tax panel convenes
"We're all in a fish bowl built out of a magnifying glass," a Berkeley City Councilmember told the panellists, referring to the national attention and strong community interest in the initiative.
Berkeley taxes sugar-sweetened beverages one cent per ounce. The tax generated $116,000 in its first month of operation.
The UC ANR panelist is Pat Crawford, the senior director of research for the Nutrition Policy Insititute, an organization of experts from throughout the University of California system brought together to share, synthesize, develop and collaborate on nutrition policy research.
In a recent Q&A with the UC Food Observer, Crawford commented on efforts to reduce consumption of sugar-sweetened beverages.
"We have strong evidence of sugar's contribution to diabetes, heart disease, obesity and dental caries," she said. "Hopefully educational materials for the public, including MyPlate, can begin to include water as the beverage that is first for thirst."
