Are Sugared-Beverage Bans an Effective Employer Wellness Strategy?

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Health impact of sugared beverages

Sugared beverages account for the majority of excess calories Americans take in. Accordingly, a person’s intake of sugared drinks tracks very neatly to his or her risk of diabetes and cardiovascular disease. Even artificially sweetened beverages are linked to early death, possibly through their effect on the bacteria, or “microbiome” growing in our intestines. But getting people to drink less of them is a vexing problem. Countries and cities including Mexico, Philadelphia, and Berkeley, California, among many others, have experimented with taxing sugared drinks, with mostly health-positive results. New York City under Mayor Michael Bloomberg attempted to limit the size of sugared drinks that could be sold to sixteen ounces or less, a move that was eventually blocked by the courts. And banning sugar-sweetened beverages in schools has not reduced consumption, at least in survey data.

Is banning the sale of sugared beverages effective?

Recently the we’ve seen the results of a sugared-drink sales ban implemented by the University of California at San Francisco (UCSF) in 2015 (students and employees were still able to bring drinks on-campus). Investigators followed the habits and health indicators of 202 volunteer subjects before and after the prohibition. Ten months after the ban, subjects’ consumption of sugared drinks was down by almost half: 48.5 percent. Even though the participants still drank a large quantity of sugared drinks after the ban—18 ounces a day, on average—they saw dramatic improvements in health. They lost almost an inch from their waists, and the fraction of the study population who decreased their drink intake the most saw improvements in insulin resistance, the phenomenon that leads to diabetes.

Obstacles to overcome

So the science of limiting sugared drinks at the worksite seems sound, at least in terms of reducing the risk of employee illness. But major obstacles threaten such policies: first, the happiness of workers is likely to be affected, at least in the short-term. Employees may rebel against a workplace culture they perceive as too paternalistic. This viewpoint was exploited by tobacco companies during the implementation of smoking bans in the recent past. This is where an honest outreach program to employees would be worthwhile: we know that excess sugar intake is linked to depression, and that improved dietary habits can profoundly improve mood in depressed people. Sharing these stories with employees in an engaging way that shows light at the end of the sugared-drink tunnel may help. After all, a decade after widespread smoking bans, norms have shifted to the point that a re-introduction of smoking in worksites and restaurants would be met with fierce opposition.

Second, your company may have a contractual arrangement with beverage vendors. This is particularly true of institutions of higher learning. However, possibly sensing the movement of the tide away from sugared drinks, beverage companies are frantically working to offer healthier alternatives and the National Automatic Merchandising Association, the trade organization for vending companies themselves, has pledged to make at least a third of its offered products meet the standards of at least two of the healthy food standards set by Partnership for a Healthier America, the Center for Science in the Public Interest, the American Heart Association, Centers for Disease Control and Prevention, or the USDA’s Smart Snacks. So leaving vending on-site but reducing or eliminating sugared drinks is a potential compromise.

Has your worksite attempted to change the availability of certain snack foods or sugared drinks? The Kansas Business Group on Health would love to hear about your experience.

2. Social media is a set of common platforms to draw out our worst tendencies

(note: this is a continuation of a rant from a couple weeks ago)

I know it's absurd for me to be talking about "social media" as though it's some homogenous monolith. I'm sure aficionados could tell me the subtle differences between platforms the way a sommelier could tell me the difference between a Malbec and a Cabernet. But at the end of the day, those are just two varieties of red wines, and like them, Instagram and Twitter are more similar than they are different. And one of their similarities is they tend to bring out the worst in us.

Before my departure from social media, I saw people on Facebook joining or "liking" pages devoted to searing hatred of immigrants. These same people in some cases had testified at deportation hearings for undocumented family friends. What was it about the choice architecture of that "like" button that made the sort-of-evil decision the easy one? 

This isn't that different from the other happiness-draining things our consumerist society throws at us with the promise that we'll be happier if we use them. Tobacco, junk food, and social media all want the same thing from you: they want to take away your control over your life, health, and happiness. But while we've made strides to combat tobacco and junk food, like smoke-free laws and taxes on bug juice, we seem stuck in a self-sustaining vortex that tells us that more connection, more technology, will solve our problems instead of creating new ones. If a drug hit the market and prompted some of the behaviors that we see with social media, would we applaud it?

And the children. The children. We're training our kids to avoid boredom at all costs. How many kids have you seen dialed into a phone at a restaurant? How many staring into a screen at a playground? How many being beseeched to turn down their phones while at a restaurant or basketball game?

These are not behaviors that any of us are proud of. Were you to point them out to the very people exhibiting them, they would be ashamed, right after they got done telling you off and posting on Facebook about what a jerk they just ran into at the restaurant. But pride aside, there is probably real harm being done here. I'm frankly suspicious of any claim that the fake news on social media swayed the last US Presidential election, but it certainly didn't lead to a more erudite, informed electorate, either. But a kid who sits at a restaurant with earbuds in, staring at a screen, is being trained that boredom is unacceptable. What will happen to this person the first time he's confronted with a situation that requires delayed gratification or an attention span? 

So even though I'm a bit of an anti-incrementalist, I'm hoping to see just a series of small ticks in mobile/social media use. Comedian Chris Rock is having fans lock up their phones at his shows. Jack White has been doing it for a while now. I don't think these guys are doing it out of general fuddy-duddyness; they're trying to bring out the best in their audiences and to make sure everyone has a shared experience. Schools, historically afraid of parent backlash to less-than-100-percent-available kids, are even in on the act, establishing "phone free zones" with the same technology Chris Rock is using. 

Link dump - March 8, 2017

Fewer and fewer Americans report trying to lose weight. We may be settling into our role as the one of the fattest countries on earth (we're coming for you, Tonga...). I can't help but think this is because of the many, many, many shitty options that people have had pushed on them that didn't work. Now they've given up. *sigh*

The search for the perfect artificial sweetener continues

"Let us pause here to acknowledge the sugar-frosted codependent embrace of Big Food and the American consumer. You could rightly fault consumers for their insistence on an oxymoronic product. But who has been indulging their fantasies for decades now, promising sweet, satisfying taste and no calories? Big Food, of course. Now customers are upping the stakes—and it’s not at all clear that companies can pass the test."

In what seems like a just reversal of a law that had the unintended consequence of highlighting the law of unintended consequences, after 60 years, street hockey will once again be legal in Hamilton, Ontario, under the following conditions:

  • The roadway has a speed limit of 40 km/h or less and is a local road.
  • Play happens in a place that is "safe and suitable."
  • People play no earlier than 9 a.m. and no later than 8 p.m.
  • No one plays during periods of limited visibility from fog, snow or rain.
  • Play is stopped for any vehicles. ("Car!")

Having robot minions control the lights for them may be turning kids into a bunch of lazy, entitled monsters.

No one can get you to take your medicines but you. Three reminder devices to take your medications were no better than no notification or device in a randomized controlled trial

Go. To. Bed. People who get out of bed in the morning tend to eat better and earlier in the day than night owls. Original paper here.

"We found that night owls had postponed timing of food intake, and less favorable eating patterns with higher intakes of sucrose, fat and saturated fat in the evening hours than early birds," said Maukonen, a doctoral candidate in the department of public health solutions. 

Link dump - March 3, 2017

People who cook real food and eat it at the table like human beings instead of eating processed garbage in front of a screen like drooling automatons have a lower risk of obesity. Good to know.

Wichita roads are friendlier to cyclists. I've experienced this myself, and I've meant to write a letter to the Eagle thanking the city and its drivers for not killing me, but now it's taken care of. *washes hands*

Obese people who "self stigmatize" may be at higher metabolic risk. This is an interesting hypothesis. Intuitively, I believe it; there's so much undeserved self-hatred out there among people who weigh more than they want to. But the sample size of this paper makes me suspicious. It has the smell of p-value hunting.

Aggressive treatment of subclinical hypothyroidism with levothyroxine in pregnancy probably doesn't result in smarter kids. This is disappointing.

Taxing sugared drinks makes people drink less insect bait. Go figure.

Have a good weekend

Have a good weekend