Tuesday, January 6, 2015

Tackling Our Supersized Nation; Reducing One Soda Size at a Time

Grande Starbucks coffee, McDonalds’ Big Mac double burger, and Subway's footlong sandwich: Many Americans are unable to recall a day when they did not consume one of these oversized, fattening and high-caloric foods. Easy accessibility and popularity of cheap, tempting, supersized portions, has molded the American culture, the average American’s forever expanding waistline, and compromised the general health status of the American nation. Therefore, in June 2012, when the New York City Department of Health, led by Mayor Bloomberg, proposed a portion cap on sugary drinks, it was met with sweeping opposition from NYC populations, food industries and special interest groups. I will zoom in and examine some arguments and outcomes surrounding the portion cap attempt on sugary beverages, and determine its role on nurses as primary health care providers and advocates in communities managing an obese nation.
Multiple factors contribute to a nation’s health status.With obesity as a significant factor, how can interventions be channeled to tackle obesity? Is limiting portion sizes the best option? While obesity itself seems to reflect a singular health issue, research condemns obesity as a major contributor to more than twenty comorbidities. Chronic health conditions such as hypertension, diabetes, cardiovascular disease, sleep apnea, osteoarthritis, certain cancers, and more issues, can all be linked to obesity (Ferguson, Langwith, Muldoon,& Leonard, 2010). According to the Center for Disease and Control (CDC), nearly 36% of Americans, 20 years or older are overweight and another 69%, are overweight or obese (Ruff, Akund, Adjoan & Kansagra, 2013). Increased body mass index can alter the immune system, thereby making overweight populations more prone to infections (Holm, Spector, Hicks, Carlson, & Lanuza, 2001). Management of obesity among the lists of existing comorbidities has been associated with improvements and resolution of its tailing, secondary health issues. Therefore, controlling the factors which influence obesity may be a rational approach to promoting a healthier nation.
Sugar sweetened beverages (SSB), contain a high caloric density and contribute a substantial percentage of non-nutritious calories to those who consume them regularly. When comparing daily caloric intake with non-SSB drinkers, SSB consumers have a 572 kcal greater intake (Ruff Et al., 2013). Cutting out one SSB a day can decrease body weight by one pound per week (Mayo Clinic Staff, 2012). The link between the SSB magnitude and obesity is significant.
Bloomberg proposed to downsize our supersized nation by restricting the size of SSB sold in public arenas to 16 ounces or less. In doing so, he acknowledged the obesity problem, yet instigated a passionate split in the nation’s opinions. Bloomberg attempted to limit soda sizes to encourage a decrease in SSB consumption, but with an ultimate goal to improve the general health of citizens. Some Americans viewed this as limiting their public freedom. Advocates for the bill claimed it to be no more limiting freedom than traffic lights or other laws implemented to protect consumer rights (Buchanan, 2012). Critics reasoned, that limiting SSBs will not stop consumers from purchasing multiple bottles, but will promote ingestion of greater caloric intake. However, America’s earned title as the ‘super-sized nation’ is not only due to choosing easier food options, but also cheaper ones . The ban may be legitimized, since consumers are less likely to buy multiple 16 ounce bottles than the cheaper 32-48 ounce soda option (Buchanan, 2012).
As the public worried about their freedom and their sugar cravings, special interest groups, such as The American Diabetes Association, strongly advocated this bill due to its weighty implications on their target populations. However, soda corporations opposed the bill. They argued that it restricted public freedom and potentiated financial losses. Large beverage companies, such as Pepsi, were paradoxically supported by the NAACP and the Hispanic Federation. These interest groups both  receive financial support to advance healthier living initiatives from soda corporations (Knowles, 2013). Their claims fixated on financial detriments for local bodegas, and legitimately reasoned to focus more on youth and school based health improvements. As a former supporter of a local bodega, along with my 400 student school population, sugar intake and portions of allowances spent on super sized sodas were significant.
Research indicates that what people want is often influenced by the way their choices are crafted (Surowiecki, 2012). A soda ban would make smaller sizes the default option (Williams, 2013). Ingesting more would then take extra money and effort, thus decreasing overall SSB consumption for the average citizen. While this legitimizes the attempt to manage obesity via control of portion sizes, a primary nursing perspective might choose to target the obesity issue through education and health promoting programs.
Nurse theorist, Betty Neuman's approach to wellness, highlighted the importance of the client's perception of the problem and their agreement with the plan of action (Lowry, Beckman, Gehrling & Fawcett, 2007). Prior to initiating change, individuals must first acknowledge the issue, then nurses can assess how they perceive it (Burke & Wang, 2011).
Organizing programs which educate the public on obesity and its comorbid health effects might self-motivate healthy behaviors. Knowledge regarding sugar’s detrimental health effects will make individuals acutely aware of its impacts whenever they attempt to ingest an oversized soda.  The education may start in schools; when children are taught by example through physical activity programs and healthy lunches, healthy behaviors become second nature (Holm et al., 2001) Initiatives in childhood settings have been and continue to be in effect, but services for adults are equally important so that youth initiatives can be maintained at home (Mello, Pomeranz,& Moran, 2008). Nurses can advocate programs, such as adult obesity management programs, physical activity programs, and influence food industries to expand healthy menu options (Holm et al., 2001).
In March 2013, The Supreme Court of NY ruled against the bill proposal to limit SSB sizes. Bloomberg’s efforts were not in vain. Research indicates that barriers to obesity management reflected both public stigma, which prevented practitioners from more firmly addressing the issue with patients, as well as inconsistencies in health care programs and services (Gunther, Guo & Sinfield et al., 2012). Despite the halt on its passage, the fierce public outbursts of opinions in response to the portion cap attempt imparted by the media unveiled the hush on the obesity matter. With the silence broken, opportunities for nursing advocacy towards implementing and improving health initiatives might have risen.
I’m a runner, and a nurse on a bariatric, surgical unit. I have passion for both nursing and with being fit and healthy. I support any public attempts at advancing health initiatives for our nation. Whether for this bill or against it, all sides had acknowledged that the obesity issue and its relationship with SSBs exists. To the public the bill was a reminder that lifestyle changes must occur. For nurses, it instigated advancement from inertia to active championing for change. For me, it got me running faster, self limited my own version of SSB intake from orange juice or grape juice to simply water and milk, and gave me a topic to share on a blog post.
However, while the proposed bill might have only affected SSB intake outside homes, but not limit attainability for commercially sized SSBs from Costco, Walmart and other industries offering the oversized options, it launched new public awareness on this issue. Our nation’s preoccupation with obesity, increases nurses and healthcare advocates opportunities to inititate more policies to shape healthier lifestyles from an eager audience; the people themselves. The bill proposal was an instrumental start to tackling this nationwide sugar killer, because it seized the public’s attention on obesity. It has now been conceded, that the public will need more than just a soda ban, but perhaps a soda tax, or more voices and actions to stimulate more measurable changes to the waistlines and health statuses of  America’s “Supersized” nation.



*Excerpt from a paper i had written on a healthcare policy that I am passionate about.



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