Taxing Sugar-Sweetened Beverages To Prevent Obesity

In addition to the series of article on long-term outcomes in bariatric surgery, the 2018 special issue of JAMA on obesity, also features several articles discussing the potential role of taxing or otherwise regulating the use of sugar-sweetened beverages (SSB) as a policy measure to address obesity. In a first article, Jennifer Pomeranz and colleagues discuss whether or not governments can in fact require health warnings on advertisements for sugar-sweetend beverages. The discussion focuses on an injunction issued by the Ninth Circuit Court on the enforcement of San Francisco’s requirement that sugar-sweetened beverage (SSB) advertisements display a health warning statement, finding that this law likely violated the First Amendment rights of advertisers of SSBs. The background for this court decision was the fact that San Francisco passed a law requiring SSB advertisers to display: “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” In its decision, the court felt that the proposed warning label was not scientifically accurate, as it focussed exclusively on “added sugar(s)” rather than sugars overall. It appears that there is no scientific evidence suggesting that “added sugars” are any more (or less) harmful than the “natural” sugar occurring in any other foods or beverages). However, as the authors argue, warning on SSB may well be warranted as “In addition to being a major source of added sugar in the US diet, the liquid form of SSBs could enable rapid consumption and digestion without the same satiety cues as solid foods. SSBs also contain no relevant ingredients to provide offsetting health benefits, in comparison with sweetened whole grain cereals, nut bars, yogurt, or other foods with added sugars, which can have healthful components. Furthermore, the associations of SSBs with weight gain, obesity, type 2 diabetes, and heart disease are each stronger and more consistent than for added sugars in solid foods. In addition, compared with other foods containing added sugars, SSBs are the only source for which randomized controlled trials have confirmed the observational link to weight gain.” Another point of contention identified by the court was related to the fact that the warning stated harm irrespective of quantity and would have been more accurate had it included the term “overconsumption” or at leas the qualifier “may”. Here, the authors argue that, “health risks of SSBs increase monotonically. Thus, use of the word… Read More »

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Obesity Reimagined: 2018 JAMA Theme Issue On Obesity

This week, JAMA revisits obesity with a dedicated theme issue, which includes a range of articles on obesity prevention and management (including several on the impact of taxing sugar-sweetened beverages and five original long-term studies on bariatric surgery). In an accompanying editorial, Edward Livingston notes that, “The approach to the prevention and treatment of obesity needs to be reimagined. The relentless increase in the rate of obesity suggests that the strategies used to date for prevention are simply not working.” Also, “From a population perspective, the increase in obesity over the past 4 decades has coincided with reductions in home cooking, greater reliance on preparing meals from packaged foods, the rise of fast foods and eating in restaurants, and a reduction in physical activity. There are excess calories in almost everything people eat in the modern era. Because of this, selecting one particular food type, like SSBs, for targeted reductions is not likely to influence obesity at the population level. Rather, there is a need to consider the entire food supply and gradually encourage people to be more aware of how many calories they ingest from all sources and encourage them to select foods resulting in fewer calories eaten on a daily basis. Perhaps tax policy could be used to encourage these behaviors, with taxes based on the calorie content of foods. Revenue generated from these taxes could be used to subsidize healthy foods to make them more affordable.” Over the next few days, I will be reviewing about the individual articles and viewpoints included in this special issue. In the meantime, the entire issue is available here. @DrSharma Edmonton, AB    

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Vote of Thanks From The Obesity Chair

10 years ago, I was enticed to take up an endowed “Chair” in obesity research and management at the University of Alberta with the task to develop and lead the fledgling bariatric program at the Royal Alexandra Hospital. The decision to move to the University of Alberta from a prestigious Tier 1 Canada Research Chair in obesity at McMaster University, where my research enterprise was moving along just fine, was largely prompted by the Ontario Government’s bumbling indecision (despite all of my considerable and enthusiastic advocacy efforts on behalf of my patients) about promoting much needed bariatric services in Ontario (as a side note, only six weeks after I had signed on with the University of Alberta, the Ontario government, after much to-and-froing, finally did announce substantial funding for a province-wide bariatric program, which continues to this date as the Ontario Bariatric Network). Despite my sadness at leaving my most wonderful and supportive colleagues at McMaster University, I have not for a moment regretted my move to Edmonton. Not only did I find another set of as supportive colleagues at the University of Alberta but also the committed and dedicated staff within Capital Health (now part of  Alberta Health Services), all of which enthusiastically supported the creation of a now world-class academic bariatric program in Edmonton. With well over 100 peer-reviewed publications to show for (with a notable mention to the colleagues who helped develop the Edmonton Obesity Staging System and the 5As of Obesity Management), the academic work in obesity was only a rather small part of my activities as “Chair”. Together with my colleagues at Alberta Health Services, we supported a total of 5 bariatric clinics across the province, all of which are now up and serving Albertans living with severe obesity –  each adapted to local resources and interests. Of these, the Edmonton Adult Bariatric Specialty Program at the Royal Alexandra Hospital of course continues as the flagship program, offering a full suite of behavioural, medical, and surgical treatments for Albertans with severe obesity. With my move to Edmonton, so did the national office of the Canadian Obesity Network (co-hosted by the University of Alberta and Alberta Health Services). As readers will be well aware, this pan-Canadian network of now well over 15,000 obesity researchers, health professionals, trainees, and now 1000s of public supporters, continues to grow and steadfastly pursue its important mission of promoting obesity research,… Read More »

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European Collaborating Centres for Obesity Management (EASO-COMs)

This week, I am in Tønsberg, Norway, speaking at the annual meeting of the European Association for the Study of Obesity (EASO) Collaborating Centres on Obesity Management (COMs). This is a pan-Euoropean network of over 75, that includes academic, public and private clinics where children and adults with obesity are managed by holistic teams of specialists delivering comprehensive state-of- the-art clinical care. The EASO-COMs also work closely to ensure quality control, data collection, and analysis as well as for education and research for the advancement of obesity care and obesity science. Current plans foresee establishing 100 new COMs by 2020. There are also plans to develop an international exchange and mentoring program to increase competencies and treatment knowledge across Europe. Other important EASO initiatives in this regard include a knowledge transfer series involving e-Learning modules for obesity management based on the Canadian Obesity Network’s initiative with mdBriefCase. I certainly look forward to networking with and learning from my European colleagues over the next couple of days. Further details on the criteria for becoming a EASO COM are available here. @DrSharma Tønsberg, Norway

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Guest Post: Australian GPs Recognise Obesity As A Disease

The following is a guest post from my Australian colleague Dr. Georgia Rigas, who reports on the recent recognition of obesity as a disease by the Royal Australian College of General Practice (RACGP). Last week, the Royal Australian College of General Practice (RACGP) President, Dr Seidel recognised obesity as a disease. The RACGP is the first medical college in Australia to do so. This was exciting news given that we have just observed World Obesity Day a few days ago. According to the Australian Bureau of Statistics1, over 60% of Australian adults are classified as having overweight or obesity, and more than 25% of these have obesity [defined as a Body Mass Index (BMI) ≥30] (ABS2012). Similarly in 2007, around 25% of children aged 2–16 were identified as having overweight or obesity, with 6% classified as having obesity (DoHA 2008). These are alarming statistics. The recent published BEACH data for 2015-162, showed that the proportion of Australian adults aged 45-64yo presenting to GPs has almost doubled in the last 15+ years. Worryingly the numbers are predicted to continue rising, with 70% of Australians predicted to have overweight or obesity by 2025. Embarrassingly, the BEACH data also indicated that <1% of GP consultations centred around obesity management. So obviously what we, as GPs have been doing..,or rather not doing…isn’t working! The RACGP’s General Practice: Health of the Nation 2017 3report found Australian GPs identified obesity and complications from obesity as one of the most significant health problems Australia faces today and will continue to face in coming years as the incidence of obesity continues to rise. But what are we doing about it?…. I think the answer is evident… clearly not enough! Thus, we can only hope that this announcement by the RACGP will have a ripple effect, with other medical colleges in Australia and then the Australian Medical Association following suit. So what does this mean in practical terms? For those individuals with obesity (BMI ≥30) with no “apparent” comorbidities or complications from their excess weight…[though you could argue they will develop (if not already) premature osteoarthritis of the weight bearing joints…..] would be eligible for a chronic care plan [government subsidized access to a limited number of consultations with allied health services] given the chronic and progressive nature of the disease. It also highlights the need for GPs to start screening ALL patients in their practice-young and old; for… Read More »

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