Don't Drink That!

Michael Bloomberg, the mayor of New York City, is proposing a ban on the sale of "sugary soft drinks" in containers larger than 16 ounces in restaurants, movie theaters, stadiums, and arenas. This is just the latest move in his campaign to get people to make more healthful dietary choices.

Given that people can simply go back for seconds, it would seem that the effect of this restriction might be educational, in that it would force New Yorkers to think about the fact that they are consuming large amounts of sugar in their beverages. The city's health department already runs ads in the subways telling consumers this is not good for them.

It's possible there are many people who don't already know this, but I'm skeptical. One need not conduct a laborious search to find information about this sort of thing. Drinking Coca-Cola®? An eight-ounce serving has about 100 calories from sugar, the same amount you'd get by adding four well-rounded teaspoons of sugar to a cup of coffee. The effect of this is not a mystery, either. Just one such 8-ounce beverage per day will add ten pounds of fat to your body in a year. Put another way, the substitution of a non-caloric beverage, such as water or a diet soft drink, would translate into a ten-pound weight loss in a year. If you're the sort of person who goes through a two-liter bottle of regular soda pop each day, getting rid of those calories would help you drop 80 pounds in a year, assuming you didn't just replace the calories by eating chocolate chip cookies. We all have to make choices, of course, so if I'm keeping my calories constant, I'll definitely take the diet cola and eat the chocolate chip cookies, thank you very much.

The problem is not a lack of information. Everything is online nowadays, and a few keystrokes on a computer, tablet, or smartphone will summon the caloric content of just about anything. If you don't know, it's because you don't want to know. And if you don't want to know, Mayor Bloomberg is not going to change that by keeping you from buying more than 16 ounces in a single container at a time. He could send you off to a reeducation camp in the countryside, like they did in China during the Cultural Revolution, but I think the libertarians and others opposed to the "nanny state" approach to public health would find this more objectionable than the soft drink limit.

Mayor Bloomberg is correct when he opines that obesity is a major public health problem in the United States. When people register as patients in the emergency department where I work, a nurse enters height and weight in the computer system, and body mass index (BMI) is automatically calculated. This is one of many bits of information I can see at a glance for every patient. So many patients are overweight that I am pleasantly surprised when I see a BMI less than 25.

Public education is a good thing. I readily concede that it may help if people are frequently reminded of things they already know. And educating our children about healthful dietary choices is certainly a sensible approach. So Michelle Obama's focus on childhood obesity may make a difference in the lives of some Americans. Perhaps as a result of her interest in this problem, some of us will grow up choosing our food and beverages more wisely and getting more, and more regular, exercise. The Bush Administration's efforts to improve public education, labeled "No Child Left Behind," have no shortage of critics, but I'm hoping Mrs. Obama's programmatic vision, which I have whimsically dubbed "No Child with a Fat Behind" will be better received and more effective.

Government's efforts to protect us from ourselves have produced mixed results, mostly because we stubbornly resist. We have seatbelt laws, and yet people drive without wearing their seatbelts, with predictable and tragic results when they are involved in crashes. We have motorcycle helmet laws, and riders generally comply where such laws are in effect - mainly because police can see so easily when riders are violating the law. But everywhere that there are helmet laws, freedom-loving bikers incessantly lobby for their repeal. It is difficult for me to believe that the families of unhelmeted motorcyclists who die or suffer severe, permanent disability from head injuries are thankful for the legislative efforts of the libertarian bikers. Yet those efforts continue unabated (pun intended).

This time of year I begin seeing many young people who somehow find it appealing to ride all-terrain vehicles in the dark, in the woods, drunk, with no helmets or protective clothing. The results of such behavior are predictable, even if you are not too bright and have never set foot into the trauma bay of a hospital emergency department.

So what, exactly, does Mayor Bloomberg think will be the effect of figuratively shaking the nanny state's finger at such stubborn folk when they want to buy a soft drink in a Big Gulp size? Bloomberg likes limits. He thinks if laws limit citizens to purchasing one handgun per month, we will have less violent crime committed with guns.

Maybe that's true. And maybe if you can't buy a 20-ounce soft drink at Yankee Stadium, that will help you get thinner.

But Americans don't like limits. And New Yorkers don't like Bloomberg's policies, at least judging by a 44% approval rating in one recent poll. We do like information. (Consider Wikipedia's estimated 3 billion page views per month in the U.S., if you have any doubts about that.) It's just that we like to decide for ourselves what to do with that information.