Dr. Wendel Brunner, Director of Public Health for Contra Costa County Health Services, has made the problem painfully clear: one-third of Richmond’s African-American and Latino fifth and seventh graders are obese. Another 20% in each group are overweight. Without a successful intervention, Dr. Brunner warns that most of these children will suffer from diabetes and premature coronary heart disease, and many will not live as long as their parents.
What would a successful intervention look like?
Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention, has said that a one-cent per ounce tax on sugar-sweetened beverages might be “the single most effective measure to reverse the obesity epidemic.” The American Heart Association, the Institute of Medicine, the American Public Health Association, the American Academy of Pediatrics, The American Medical Association, The American Association of Retired Persons, and the United Nations have all endorsed the idea. The Richmond City Council has decided to give it a try.
Richmond’s Proposed Ordinance re: Sugar-Sweetened Beverages
An ordinance on the November ballot in Richmond would impose a business license fee on all businesses in the city that sell sugar-sweetened beverages. Under the proposed ordinance, each business will be required to pay the city one cent per ounce of sugar-sweetened beverage sold each year. This can be calculated from inventory rather than tracking each sale. In addition, the City is working on a toolkit to make compliance for local businesses as easy as possible. The structure of the ordinance allows all of the work on the government side to be done by city employees and does not require help from the State Franchise Tax Board. It will be up to retailers to decide if they will pass the tax on to consumers, but we expect them to do so.
What’s wrong with sugar-sweetened beverages?
Can’t any food or beverage be part of a balanced diet, e.g. have a cola with dinner but skip dessert? That sounds reasonable, but it’s based on old science. What the new science is telling us is that our bodies actually work a bit differently than that. We are not equipped to metabolize large fructose loads without severe adverse health consequences.
In nature, sucrose or fructose is always bound to fiber and that prevents us from taking in too much at one time. Our livers can easily handle what’s in an apple or two. But when we consume huge doses of fructose in water, either from high fructose corn syrup or from sucrose, we present the liver with more than it can safely handle. The liver has no storage mechanism for fructose, so whatever it cannot metabolize, it converts to fat. Some of the fat ends up on our waistlines, but it’s the fat we don’t see that hurts us.
Our livers get packed with fat and begin to malfunction. Fatty livers become “deaf” to the hormone insulin, which regulates sugar and fat metabolism. The pancreas responds by going into overdrive and making high doses of insulin, and eventually poops out, resulting in diabetes. Fatty livers also make unhealthy cholesterol (small dense low density lipoprotein (LDL) particles), which can plug up the arteries of the heart and cause a heart attack. This is why drinking sugar-sweetened beverages increases our risk of a heart attack by 20%.
Further evidence that sugar-sweetened beverages are to blame
Dr. Kimber Stanhope replaced the toast and crackers that healthy 18-24 year-old volunteers had been eating, calorie for calorie, with a sugar-sweetened beverage. Within two weeks, these healthy volunteers were producing alarmingly high levels of unhealthy cholesterol.
The fact is that we Americans have drastically increased our sugar intake during the past generation, and more than half of the added sugar has come from sugar-sweetened beverages. Estimates are that at least 20% of the weight gained by Americans in the last generation was due to sugar-sweetened beverages.
Why a tax instead of just more education?
The new science says that too many sugary drinks is the main culprit in weight gain, diabetes, premature heart attacks, and even some cancers. So why not just educate folks and leave it at that?
Public health literature has lots to say about this too. Perhaps it’s no big surprise, but we humans are a stubborn lot. Education alone was not enough to curtail tobacco use, to get us to put on our seatbelts, nor to designate a safe driver when we had too much to drink. We needed a “stick” to go along with the “carrot.” Cigarette taxes, and penalties for drunk driving and not buckling up moved us to behave in healthier ways. That’s what we plan to do in Richmond by taxing sugar-sweetened beverages.
How will Richmond use the proceeds?
We can do even more to improve public health by directing the new tax revenue to programs and projects that promote healthy eating and active living. We also know from our work in the Richmond community that residents will support the sugar-sweetened beverage tax if the revenue is used to create more after school sports programs and make them less expensive; provide adequate sports fields; provide healthier school meals, and nutrition and cooking classes; and provide medical care for children with diabetes who can’t afford care. We can guarantee enough votes on the future city council to make that package a certainty if the ballot measure passes. We estimate we will have $3 million to invest in our children’s well-being.
Moreover, we will have made history by being the first municipality in the nation to implement the recommendation of the CDC and others to save our children from the obesity epidemic. Finally, because of the campaign for this ordinance, many more folks in Richmond and the surrounding areas will know and understand the new science than perhaps anywhere else in the United States.
Learn more at www.fit-for-life.org.
Jeff Ritterman is a Richmond City Councilmember (elected November 2008) and Former Chief of Cardiology, Kaiser Richmond Medical Center. Dr. Ritterman has been active in international health. In addition to his international work, Dr. Ritterman has been working to improve health in his own local community. He has served on the Public and Environmental Health Advisory Board of Contra Costa County since 1990. He is on the steering committee of the San Francisco Bay Area chapter of Physicians for Social Responsibility (PSR), and serves on the Richmond Mayor’s Task Force on Environmental Justice and Environmental Health. The proud father of a large combined family, Dr. Ritterman has children who are active in the fields of Public Health, Psychology, Music, Medical Technology and Engineering.
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