Tuesday, June 12, 2012

Obesity Ills That Won't Budge Fuel Soda Battle By Bloomberg

By Winnie Hu for The New York Times

A hospital offers Zumba and cooking classes. Farmers markets dole out $2 coupons for cantaloupe and broccoli. An adopt-a-bodega program nudges store owners to stock low-fat milk. And one apartment building even slowed down its elevator, and lined its stairwells with artwork, to entice occupants into some daily exercise.

In the Bronx, where more than two-thirds of adults are overweight, the message has been unmistakably clear for a long time: Slim down now.

But, if anything, this battery of efforts points to how intractable the obesity problem has become in New York’s poorest borough. The number of the overweight and obese continue to grow faster in the Bronx than anywhere else in the city — nearly one in three Bronx adults is obese — leading the city’s health commissioner to call it “ground zero for the obesity epidemic problem.”

So it was to the weight-burdened Bronx that Mayor Michael R. Bloomberg went last week to make the case for his controversial proposal to ban supersized sodas and sugary drinks. Standing in the lobby of Montefiore Medical Center, the borough’s largest hospital, he was flanked by doctors who spoke of treating more patients than ever with diabetes, hypertension and other obesity-related diseases.

Critics have described the proposed soda rule as interfering with a matter of personal choice, calling instead for less intrusive means to address the obesity problem, through education and access to healthy foods. But the Bronx experience helps explain why Mr. Bloomberg and city health officials embraced the aggressive new regulatory tack after years of trying, and failing, to curb obesity through those types of measures.

At parks, bodegas and fast-food restaurants across the Bronx, many residents had not heard of most of the previous anti-obesity efforts. “If I did, I don’t think I’d be this big right now,” said Faith Coleman-Njikeng, who, at 5-foot-2 and 200 pounds, has never been heavier. “They didn’t do a good job of publicizing them.”
For others, nothing had worked. Brett Toney, who is 5-foot-9 and 210 pounds, and his wife, who is also obese, have sworn off fried foods, attended health fairs, used a coupon for a farmers markets and walked in a park for exercise in the past year. He did not lose a single pound. She gained 20.

Kelly D. Brownell, the director of the Rudd Center for Food Policy and Obesity at Yale University, said that while education and incentives were popular with the public, those programs tended to reach relatively small numbers because of their limited funds. He said he supported the use of regulations like the city’s proposed ban on large sodas as a necessary step toward curbing obesity.

“It completely makes more sense to make the environment healthier rather than to just do pure education,” he said.

In defending his proposal, Mr. Bloomberg said at Montefiore that the ban was not intended to tread on anyone’s rights, and he noted that more than individual liberties were at stake. “We are absolutely committed to doing everything in our power to help you get on track and stay on track to maintain a healthy lifestyle,” he said. “Because this isn’t your crisis alone — it is a crisis for our city and our entire country.”
Though the Bronx has the largest percentage of overweight adults, a staggering 70 percent, the other four boroughs also have seen increases in the past decade. Sixty-two percent of Staten Island adults are overweight; followed by Brooklyn, at 60 percent; Queens, at 57 percent; and Manhattan, at 47 percent, according to city health data.

According to the Centers for Disease Control and Prevention, about 68 percent of adults in the United States were either overweight or obese in 2008.

“It’s simple math: it’s increased intake of calories and decreased exercise,” said Dr. Steven M. Safyer, the president and chief executive officer of Montefiore, which spends about $7 million annually on anti-obesity and related programs, including community health fairs and free Zumba, yoga and cooking classes for thousands of employees, patients and local residents. The hospital no longer sells sugary drinks, deep fried foods or ice cream on the premises. Dr. Safyer supports the proposed soda rule.

During a recent health fair at St. James Park, about 100 people had their weights and blood pressures measured. Community groups handed out brochures for nutrition programs, jump-ropes, energy bars and even a card showing portion sizes of foods like rice and beans.

Some left with optimism that they would change their ways. “I’m going to take care of myself more,” Jose Jimenes, who is 5-foot-6 and 200 pounds, said after learning he had high blood pressure.

City health officials and community leaders insist that all the anti-obesity measures have helped some people, though they acknowledged it was not enough in a borough of 1.4 million.

“I wouldn’t call anything we’ve done a failure until we put them all together,” said Dr. Thomas A. Farley, the health commissioner, who believes the soda rule will work together with the previous efforts.
There is little available data showing the cost of the programs, the number of participants or the results. 

Aides for Mr. Bloomberg noted that the efforts had worked, with more than 500 bodegas and 20 supermarkets in the Bronx now stocking healthier food. But they did not report the extent to which whole-wheat bread was replacing white bread or low-fat milk was replacing whole milk in customers’ shopping baskets.

The impact of other programs was also inconclusive. The mayor’s aides said the city had issued 200 permits for green carts, which sell fresh fruits and vegetables, in Bronx neighborhoods since 2008, and that the $2 coupons for farmers markets, known as Health Bucks, had an 88 percent redemption rate in the Bronx, up from 81 percent the year before.

Ruben Diaz Jr., the Bronx borough president, said that while the mayor had proposed a bold idea, the city should focus on expanding community and education programs rather than trying to dictate soda sizes.
“Ultimately people need to be responsible for their own actions,” Mr. Diaz said, explaining that “if they’re of a certain mind-set, they’re going to continue to have poor eating habits, and we’re still going to have the same problem.”

Outside a bustling McDonald’s near Yankee Stadium, many Bronx residents said the only effect of the proposed ban would be on their wallets: they would have to buy two small cups of soda ($2.58) instead of one large ($1.89) to get their fill.

“If I eat cheeseburgers and fries, I’m going to get dehydrated and that little cup is not enough,” said Jessica Torres, 22, a mother of two.

Arla Lucien, 27, a post office clerk trying to lose 40 pounds, said a ban would no more help her stick to her diet than the calorie counts posted on menus, another anti-obesity measure that city leaders hoped would lead consumers to make healthier decisions. She still orders her Big Macs.

“Really, you’re going to tell me how to eat and drink?” she said. “That’s not going to work. It’s hard to do with kids; you think it’s going to work with adults?” 

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