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Tuesday, September 23, 2014

"A Proposed Ban on the Sale To and Possession of Caloric Sweetened Beverages by Minors in Public"

That's the title of this article by James G. Hodge Jr., Leila Barraza, Susan Russo, Kellie Nelson, and Greg Measer. Here is the abstract:

Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America’s youth.
This abstract sounds uncontroversial, and doesn't do justice to the article's attention-grabbing title. So here is a selection from the introduction that more accurately reflects the paper's content:

In the sections below, we take apart and analyze the legal and policy issues underlying a proposed ban on the sale to and possession of CSBs by minors in all public places. To the extent our proposed ban is legally viable, buttressed by available scientific evidence on the harms related to minors’ consumption of CSBs, closely tied to reducing gains in childhood obesity, and already in place in select school districts, it reflects the future of public health policy within and across states.

Some thoughts:

First, the article admits that current policies to reduce the consumption of sugary drinks by children are not succeeding. One reason for the lack of success is that "public opinion" stalls the progress of reform -- which presumably means that people tend to resist passage of restrictions on sugary drinks. The article claims that a full ban on sweetened drinks will succeed where these other restrictions have failed. But it is unclear how a complete ban would overcome the same obstacle of public opinion, especially if public opinion is enough of a barrier to frustrate less-exhaustive bans. Accordingly, it is unclear how this complete ban "reflects the future" of public health policy.

Second, on page 112, the authors state that their ban would not apply to fruit drinks to which no sugar has been added. But administering this ban would be quite difficult, since even single brands of fruit juice may contain varieties in which no sugar is added, and varieties with added sugar. Moreover, those varieties with added sugar may not be obvious -- since it has been my experience that only the varieties without added sugar have labels proclaiming the lack of such sugar. Customers who are under 18 would need to differentiate between these different varieties of drinks, and this same differentiation would need to be carried out by the store's cashiers. The breadth of the authors' definition therefore threatens to create a great deal of confusion for both customers and store employees.

Third, on that same page, the authors state that their definition of "caloric sweetened beverages" applies to milkshakes. This shocks the conscience.

Fourth, the ban would only apply to beverages that are sweetened with "caloric" sweeteners. This would exempt diet sodas from the ban. It is therefore difficult to see how a ban on both the purchase and public possession of these beverages could be enforced. Say a store has a soda fountain that is out of the immediate sight of the store clerk. A mischievous minor could claim that the drink he is purchasing is a diet soda, when in fact it is a regular soda. How is the clerk to verify that the minor is telling the truth?

And say that a police officer spies a group of youths outside a local gas station sipping on beverages that appear to be soda. The authors of this paper propose a ban that would apply to the possession of sugary drinks by minors in public. But how is the officer to determine whether the minors' drinks are regular or diet sodas? There must be some way for the authorities to enforce this new law -- perhaps the authors are suggesting that officers taste young people's beverages. Instead of "stop and frisk," perhaps officers will "stop and sip" minors' beverages in an effort to determine whether their drinks are calorie-free, or carbonated contraband.

The authors are correct to point out the problems caused by childhood obesity. And they are correct to claim that an outright ban on sugary drinks would probably be within state governments' powers. But despite their promise to explain every component of the ban, these six coauthors are unable or unwilling to confront the very apparent objections that this ban would be politically unfeasible and unenforceable.

Childhood obesity is a problem. A complete ban on the sale and possession of sugary beverages is a radical solution. Defending the feasibility of this solution requires more than three full pages of text.

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