Over the last decade, NYC Mayor Michael Bloomberg and Health Commissioners Thomas Farley and Tom Frieden have mounted unprecedented campaigns to tackle some of the city’s most intractable public health problems, from smoking to teen pregnancy. On the last day of the 2013 Annual Research Meeting, a policy roundtable called “Nudging Food Choices through Public Policy: The New York City Experience in the Bloomberg Era” convened experts to share insights on the complicated legal and regulatory issues surrounding such policies aimed at addressing obesity. Session chair Y. Claire Wang of Columbia University described how the multi-pronged “Bloomberg-Farley-Frieden” model targets obesity by:

  • Introducing standards (soda-free schools, SNAP restrictions);
  • Providing information to educate consumers (menu labeling, media campaigns);
  • Limiting access to unhealthy items (trans fat ban); and
  • Enhancing access to healthy foods (healthy bodegas, Health Bucks).
This model addresses individual choices, as well as the structural and environmental factors that a 2012 Institute of Medicine report describes as influencing the prevalence of obesity more than one’s eating patterns and physical activity.

Why is the city adopting these strategies? 

Maura Kennelly of the New York Department of Health and Mental Hygiene emphasized that above all, the “Bloomberg-Farley-Frieden” model is data-driven and grounded in evidence. She quoted Bloomberg (quoting W. Edwards Deming): “In God we trust; all others bring data.” She added that the policies aim to make the healthiest choice, the easiest choice. Yet while policies that increase access to healthy foods are widely accepted, efforts to limit access to unhealthy foods have been much more controversial.

On what grounds are the policies being challenged? 

Jennifer Pomeranz of Yale University’s Rudd Center for Food Policy & Obesity outlined the main legal arguments raised in the lawsuit against the proposed 16oz limit on sugar-sweetened beverages (SSBs). First, the suit argued that the proposed regulation contained arbitrary loopholes and exceptions. However, Pomeranz contended that these were intentional, as the scientific evidence around milk-based drinks is not as definitive as with other SSBs, and the city does not have jurisdiction over corner stores and other exempted establishments (e.g. 7-Elevens). Second, the suit alleged that the health department overstepped its authority by banning legal items. Yet, SSBs were not banned, as people were free to purchase as many 16oz drinks as they liked. Pomeranz encouraged the audience not to be deterred by NYC’s experience, and— except in states that have pre-empted local authority to nudge food choices with “Anti-Bloomberg” laws—to continue testing and implementing their own programs.

How do we know if the policies are working?

Brian Elbel of New York University emphasized that estimating the impact of obesity policies is very challenging. This is due to tensions between evaluating short- vs. long-term results, using lab-based vs. real-world research design, and the rapid pace of policymaking vs. the slower pace of evidence generation. For instance, research suggests that calorie labeling has had minimal impact of on food purchasing and consumption, but these studies have focused on point-of-sale decisions rather than longitudinal changes in eating behaviors.  Sometimes, the proof of the (trans-fat-free) pudding is in the eating; we won’t know what policies will work until we try them.

What does the public think?

While NYC’s public health campaigns have garnered widespread attention, according to Colleen Barry of the Bloomberg School of Public Health, public acceptance of these efforts is far from universal. Only 22 percent of Americans support a penny-per-ounce excise tax on SSBs and only 26 percent support a portion cap. However, public opinion is far more favorable on limiting SSBs in schools and changing nutrition labeling requirements. Citing the critical importance of messaging environments in transforming the way the public thinks about obesity, Barry urged a research-driven effort to identify communication strategies to encourage public acceptance of these policies.
Panelists agreed that shifting public perception from seeing obesity as primarily caused by individual behaviors toward a broader understanding of contributing structural and environmental factors will bolster acceptance of public health measures that target these factors. As Elbel and Barry stressed, much more research is needed to assess the impact of these policies and educate the public. Hopefully, this work will generate the necessary evidence to inform and implement effective programs to reduce the toll of obesity in NYC and across the country.   This post was written by Abigail Schachter, Research Assistant, AcademyHealth