Public policy raises its profile in obesity battle

Sunday, January 20, 2013 | 6:00 a.m. CST

People craving a sugary soda haven't been able to find any for sale at Kansas City's Children's Mercy Hospital since Jan. 1.

Children's Mercy decided to join other hospitals working to increase the percentage of healthy beverages they sell to 80 percent and making tap water available, said Shelly Summar, weight management program coordinator at Children's Mercy.

The hospital has joined the Partnership for a Healthier America's hospital healthy food commitment that involves implementing nine healthy practices, including offering healthier drinks.

Children's Mercy, Summar said, has decided to take its efforts under the Partnership for a Healthier America one step further by stopping the sale of all "sugary" beverages.

"We believe that it's the right thing to do, and by making the healthy choice the easier choice, people are more likely to make it," she said.

The hospital still offers water, 100 percent fruit and vegetable juices, milk, flavored milk, tea, coffee and other beverages with 10 or fewer calories per 8 ounces. Diet soda is still available, but sweet tea is not allowed. The hospital will also be retrofitting some of its water fountains to become water-bottle refill stations, she said.

The ban on sugary drinks at Children's Mercy follows New York City's ban on the sale of "sugary drinks" of more than 16 ounces in restaurants, which takes effect in March. According to the law, “food establishments” will be fined $200 if they are caught selling sodas larger than 16 fluid ounces or self-serve sodas larger than this size.

According to New York's policy, sugary drinks include beverages that are non-alcoholic, sweetened with sugar or "caloric sweetener," contain more than 25 calories per 8 oz. and aren't composed of more than 50 percent of milk or a milk substitute.

Both initiatives come at a time when health professionals are coming to a consensus that education alone isn't enough to curb the obesity epidemic in America.

Public health officials interviewed in Columbia don't expect Columbia to embrace measures like the ones in New York City and Kansas City, but aren't opposed to the idea of addressing health issues through public policy.

Christine Clayton, spokeswoman for the Robert Wood Johnson Foundation, said in an email that the organization believes a policy approach is the most effective way to reduce obesity.

A September 2012 report by the foundation found evidence that Philadelphia, New York City, Mississippi and California were seeing declines in childhood obesity rates after “taking comprehensive action to address the childhood obesity epidemic” that included policy-oriented solutions.

Dwayne Proctor, director of childhood obesity programs at the Robert Wood Johnson Foundation, said 30 percent of adults in Missouri are obese, ranking the state 12th nationally. According to the Center for Disease Control, the average national childhood obesity rate is about 17 percent for children ages 2 to 19 years old.

"We see that as a creative attempt to achieve the goal," he said of New York City's new law. "I think we are going to see more jurisdictions being innovative in the way they approach this issue," he said.

Looking at Columbia

Stephanie Browning, director of public health and human services for Columbia/Boone County, said there are no plans to put limits on the sale of sodas here.

As the Show-Me state, Browning said, Missouri is "pretty fiercely independent. I don't see that being an option right now in Missouri just because I think people would not support it."

Browning acknowledged, however, that obesity needs to be addressed via public policy and noted there are a variety of ways to do that such as healthy school lunches, increasing the amount of physical activity for children in schools and extending transportation routes. Browning said studies have shown that people get their 30 minutes of daily exercise when getting to and from public transit stops.

"So, I guess my point, is that rather than looking to a single solution for obesity, like limiting sugary beverages, we should be looking across the spectrum for multiple opportunities to help people make easy changes that lesson the risk of overweight and obesity," she said in a follow-up email.

Columbia/Boone County Board of Health member Mahree Skala said one of the things about the Robert Wood Johnson Foundation is that a strong point of its programs is that it requires evaluation of what did and didn't work, which is information people across the country can learn from. Skala also said dealing with obesity requires a comprehensive approach.

"This is not policy versus individual decisions," she said.

Skala applauded Mercy Hospital's sugary beverage policy and said one of the goals of these efforts is to make healthy decisions easier for people to make.

Skala said she is waiting for evidence and evaluation of New York City's restriction on the sale of sugary drinks that public policy can be an effective tool in reducing obesity.

"I think it's been shown in other contexts that the social conditions, the availability of products that may be harmful to people, is certainly something we regulate in other areas," Skala said, citing seat belt laws and restrictions on tobacco.

"Public policy is one way to encourage healthy behavior," she said.

What the experts say

The PedNet Coalition, a Columbia-based organization that promotes bicycling and walking, was awarded $400,000 from the Robert Wood Johnson Foundation to "reverse the obesity epidemic by 2015," according to a previous article in the Columbia Missourian. This grant money is part of $500 million spread across the country by the Robert Wood Johnson Foundation's "Healthy Kids, Healthy Communities grant, the article stated.

Ian Thomas, former director of PedNet, said obesity can be addressed with educational initiatives. "And those are somewhat effective but they're not really able to have the population-wide impact that a major epidemic social problem requires," he said.

Though education can help, Thomas said, policy approaches are needed to get people to change.

Charles Menifield, professor at MU's Truman School of Public Affairs, also thinks obesity can be targeted through public policy. 

"Yes, I do think that public policy is a viable option for addressing obesity," said Menifield. "The question is, how far do I think that should go?"

Supervising editor is John Schneller.

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