by Tom Farley
A certain giant of the food industry, one that most people didn’t think of as a food company, had been ignoring us. Walmart was now a major grocery store. By 2010 it was selling between 15 and 20 percent of the groceries in America. In January 2011 its executives appeared in the national news, beside Michelle Obama, promising to “make food healthier.” By coincidence, around the same time Walmart was trying get Mayor Bloomberg’s support, over fierce union resistance, to open stores in New York City. Trying to show a friendly face, it sent Andrea Thomas, its senior vice president for sustainability, to meet with me and other city officials in City Hall.
Thomas’s Healthier Food plan sounded serious. By 2015, she said, Walmart would eliminate all artificial trans fats, cut added sugars by 10 percent in dairy items, sauces, and fruit drinks, and cut sodium by 25 percent in many categories of foods. The salt reduction requirement covered breads, meats, cheese, sauces, condiments, snacks, and packaged prepared foods. She would apply it to both private-label and branded products. Walmart’s market share was so big, I figured, that every major food manufacturer in America would have to meet its demands. Unlike the FDA, which was obligated to spend years parrying industry protests before issuing rules, Walmart could rule by decree.
This one woman, I thought, had more power over the food industry than that massive government food agency in Washington. It was a lesson as much in the feebleness of our public health agencies as in the market dominance of Walmart. I left the meeting skeptical about how the company would enforce her plan or even measure progress. The industry introduced and discontinued thousands of products every year, and Walmart didn’t have someone like Christine Curtis calculating sales-weighted average sodium levels from databases. Still, my head was spinning about the potential impact. I was most shocked, though, when I asked Thomas why she had decided to reduce salt by 25 percent. We got that from you, she said.
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The federal government’s attitude was painfully different. After the toothless HHS Nutrition Summit and the disappearing act by the federal health agencies, I decided to press a little. The food companies kept telling us that because they distributed their food nationally, the government for the whole nation should be in charge. They had a point. In a better world, the FDA would drive the initiative, with the other health agencies cheering them on.
In June 2011 I wrote to HHS secretary Kathleen Sebelius, urging her to “make sodium reduction a national public health priority” based on the Institute of Medicine report. I also asked for a meeting with Sam Kass, the personal chef and close friend to the Obamas who was running Michelle Obama’s Let’s Move! childhood obesity initiative. He now had the title of Senior Policy Adviser for Nutrition in the White House.
Kass was a muscular former college baseball player with a shaved head and a gruff manner. He didn’t respond much to my ideas on trans fats or nutrition standards for government-purchased foods, but he got animated when I brought up salt. The problem, he said, raising his voice, is “no one ever thinks about taste. No one thinks about taste!”
I don’t know what kind of pressure the food companies or members of Congress might have put on him. Still, I was dumbfounded. Did he really think that we had worked on this for years without considering humans’ taste for salt?
And then I wondered if I weren’t looking at the roadblock. Was a man in the White House trained as a chef telling Tom Frieden and FDA commissioner Margaret Hamburg that they couldn’t utter a word on salt? It was an unsettling thought.
14
“We are in a coalition with major food companies for one reason only; that is, access to power.”
The death of the soda tax in the spring of 2010 had been painful to watch. Every single year the obesity epidemic was killing far more Americans than were killed in the entire Vietnam War. The tax died not because it wouldn’t slow the epidemic or because the issue was complicated; the soda companies killed it. The soda industry was infiltrated everywhere—with bottling plants dotted across the state, restaurants and convenience stores in every neighborhood, and vending machines even in schools. All of them got a piece of the business and resisted any attempt to change it. The American Beverage Association didn’t have the street-fighter image of the NRA or the sinister reputation of the tobacco companies, but to me it looked more powerful.
The soda companies’ arguments against the tax were hollow. But if any had struck a chord with New Yorkers, it was that the government was just using the obesity epidemic to squeeze people for their money. And that made me think of a different angle.
In June 2010, Robert Doar, the commissioner of the city’s main social service agency, and I drove to Albany to meet with the commissioner of the state’s Office of Temporary and Disability Assistance (OTDA). We brought ideas about the Supplemental Nutrition Assistance Program (SNAP), which pays for groceries for low-income people. It was once called Food Stamps.
President Franklin Roosevelt had created Food Stamps during the depths of Great Depression to protect farmers from being crushed by collapsing food prices. At that time, Americans had to buy the stamps, some of which they could redeem only for farm commodities. The Department of Agriculture, which ran the program, ended it as the economy strengthened in World War II, but Lyndon Johnson revived it with his War on Poverty. In the late 1970s the federal government started giving out the stamps for free instead of selling them.
The program had grown since then, keeping its political support even when the entire nation turned against welfare programs, because it was about food. Even staunch conservatives didn’t think poor people should starve in America. In the early 2000s the USDA replaced the stamps with electronic benefit transfer (EBT) cards. In 2008 it rebranded Food Stamps as “supplemental nutrition assistance” to emphasize that the program, rather than holding back starvation, helped people get healthy food. In 2008 the USDA was running a $30 million demonstration project in which participants got extra value to their benefits if they used them to buy fruits and vegetables. During the recession that followed the mortgage security crash, SNAP grew to new heights. By 2013 the enormous program reached 48 million people, or 14 percent of Americans, and paid for $76 billion in food a year.
Across the nation, SNAP funds bought mountains of unhealthy food, like candy, chips, snack cakes, and soda. In 2010, about $5 billion a year from SNAP paid just for sugary drinks. That was five times CDC’s budget to prevent chronic diseases.
I thought the SNAP rules should match its new name and actually assist with nutrition. Only Congress could change the rules permanently, but the USDA could authorize limited demonstration projects. Any request to the USDA for a demonstration project, though, could be made only by state agencies that managed SNAP, which in New York was OTDA.
In Albany, Doar and I suggested three ideas to the OTDA commissioner. We could set health standards for foods that were eligible under SNAP. We could give SNAP recipients extra benefits to buy fruits and vegetables. Or we could require grocery stores participating in the program to stock or promote healthier items. The commissioner warmed to the ideas but thought most were too complicated for her agency to manage under complicated federal rules. In the end, we settled on the simplest change.
In October 2010, Mayor Bloomberg and Governor Paterson announced that New York State was submitting a request to the USDA for a two-year demonstration project that would remove sugary drinks from the SNAP program. It hadn’t taken much to get the governor and the mayor behind the idea. State health commissioner Richard Daines and I argued that the government shouldn’t buy, and then hand out for free, the food that was the single biggest contributor to our nation’s number-one nutritional problem—at all, but especially in the name of a nutrition program. The rule change wouldn’t affect the size of the benefit; SNAP participants would get every penny of their monthly food allowance.
This idea wasn’t new or radical. When Congress revived Food Stamps in 1964, the House version of the bill had excluded soda. Aside from SNAP,
no federal nutrition program in 2008 included sugary drinks. The school lunch program certainly didn’t allow them. The Special Supplemental Nutrition Program for Women, Infants, and Children—known as WIC—gave mothers vouchers for only a short list of food items, and soda wasn’t one. Interestingly, in 2009, when the USDA strengthened the nutrition criteria for the WIC “food package,” children on WIC began eating healthier food, and stores began stocking healthier items. If WIC could change both Americans’ diets and what was on grocery shelves, so could SNAP.
It wouldn’t have been a big change to the program. SNAP benefits are not cash. You can’t use them to buy cigarettes or beer. You can’t use them to buy pet food, paper towels, vitamins, or chewing gum, none of which the USDA considers food. And you can’t use them to buy meals in restaurants or even deli sandwiches in grocery stores. Our proposal would just add one more item to the excluded list.
And it wouldn’t have been a big change for people enrolled in SNAP. For most people, the average SNAP benefit of $133 per person each month was too little to cover the entire grocery bill. SNAP is a supplement. Families enrolled in SNAP used their own money after their monthly benefits ran out and to buy excluded items. If SNAP participants wanted to buy soda (instead of drinking water for free), they could spend their own money for it. And then they could use the SNAP benefits not spent on soda to purchase healthier foods.
Because we were proposing a demonstration project, we had to evaluate it. To write the evaluation plan, I turned to a young health department doctor, Susan Kansagra.
Kansagra has short brown hair and is petite, unassuming, and quick to laugh. She is also, I learned, confident in herself and brainy even among the health department’s whiz kids. She grew up in Greenville, South Carolina, the daughter of a pharmacist who immigrated from India. Like Amanda Parsons, in college she had considered a career in business. Then one day, while flipping through a magazine in her ophthalmologist’s waiting room, Kansagra saw a photo of a woman with a stethoscope around her neck, holding an African baby. That picture somehow struck a chord. She quietly tore out the picture, took it home, and headed to medical school.
In 2008, after finishing her residency at Harvard, Kansagra looked for jobs in New York. Also like Parsons, she heard that exciting things were happening at the health department, so she managed to get her CV into Tom Frieden’s e-mail inbox. He hired her to find and synthesize scientific evidence for him. In the first six months, she read so many scientific papers that she had to buy reading glasses because of the eyestrain. When I replaced Frieden, I asked her to help with the department’s drawn-out response to H1N1 influenza, then increasingly relied on her for initiatives to prevent chronic diseases.
We didn’t want to give the USDA excuses to reject our SNAP proposal, so Kansagra’s evaluation plan for it was scientifically rigorous. She would repeatedly survey 4,200 SNAP participants in New York City and—as a comparison—in neighboring counties, asking about purchases and consumption of sugary drinks. She would also get data on sales of sugary drinks from grocery stores, before and after the policy change. She didn’t know how many people the rule change would prompt to buy less soda, but even a 20 percent drop in sugary drink consumption would help slow obesity, and her study could detect a drop much smaller than that. Because the USDA cared very much about SNAP users’ feeling ashamed to use their benefits, she proposed to include questions on stigma in the surveys.
The SNAP proposal stirred up the press, roused opinion writers, and scrambled the usual political lineup. Most people viewed our other ideas as liberal, but Republicans and conservatives tended to like the SNAP proposal, and Democrats and liberals generally didn’t. At the same time Bill de Blasio, a staunch liberal who was then the city’s public advocate, endorsed it.
But the proposal enraged the soda companies. The day after our announcement, Coca-Cola CEO Muhtar Kent sent a letter to Bloomberg, calling the idea “unjustified and discriminatory.” PepsiCo CEO Indra Nooyi, writing the same day, was more threatening. “When we met earlier this summer,” she told the mayor, “we let you know that as we restructure our business, we are redoubling our commitment to retain and increase our investment in New York City and New York State. But apparently commitment and loyalty is a one-way street in New York. Since our meeting, attacks on our business by the City of New York have gone unabated. . . . I am particularly concerned that you have chose [sic] to focus on just one category, and assault it across the board. I am sincerely hoping we can meet and talk about how we can work together.”
I don’t know what the soda companies were saying to the USDA, but I doubt it was gentle. Days later the grocery stores complained to the agency: the Food Industry Alliance of New York State wrote that “no food inherently is bad within the context of a balanced diet. . . . Yet, by government imposing its directive into food choices . . . SNAP shoppers will be deprived of nutritional decisions heretofore left to their discretion.” It would be too complicated to distinguish sugary drinks from low- and no-calorie drinks, the stores wrote, because “with new product introductions or a change in formulary, computer checkouts need to be re-programmed, cashiers need to be educated, etc.” And knowing that the USDA cared deeply about the stigma of using SNAP, the stores claimed that “not only will SNAP shoppers feel different, they will also be treated differently than other customers.” The stores also argued that people might travel to the suburbs just to buy soda with SNAP.
All their arguments were bogus. To say that “no food inherently is bad within the context of a balanced diet” is to say that no food on grocery shelves is so toxic that it kills you quickly. That’s a low bar for deciding what to include in a nutrition assistance program. Grocery stores already had to regularly reprogram their checkout computers to distinguish items like chewing gum that were not SNAP eligible from items like candy that were; reprogramming them to distinguish Coke from Diet Coke couldn’t be difficult. As for SNAP shoppers, at checkout they already swiped an EBT card for their SNAP-eligible items, then swiped a credit or debit card or paid cash for everything else; nothing in our rule would change that, so it was hard to see how it would increase stigma. Finally, the idea that people would drive across the George Washington Bridge, paying a toll of at least $8, to buy soda with an EBT card was laughable.
The public face of the opposition, though, was not the soda companies or the grocery stores. It was “antihunger” organizations that ran food banks and advocated for SNAP. The same day the grocery store letter hit the USDA, the widely quoted antihunger activist Joel Berg sent the agency his own fiery eight-page letter. Under screaming heads like “THE PROPOSAL WOULD PUNISH LOW-INCOME PEOPLE FOR THE SUPPOSED CRIME OF BEING POOR,” he wrote that our proposal “violates the law, restricts freedom, and criminalizes hunger by eliminating the ability of low-income SNAP recipients to even occasionally obtain sugar-sweetened beverages.”
The antihunger activists were cozy with the big food companies. Feeding America, a national network of two hundred food banks, has a board with members from ConAgra, General Mills, Mars, Kroger, Walmart, and Nationwide Agribusiness. And they looked well connected to the soda companies too; the spokesman for the American Beverage Association told the Times, “Fighting hunger is a pretty heavy lift. I think we need all the hands we can get working on that cause. I don’t see a conflict here.” The antihunger groups didn’t seem ashamed about doing the bidding of the big food corporations. Edward Cooney, executive director of the Congressional Hunger Center, told the Times, “We are in a coalition with major food companies for one reason only; that is, access to power.”
• • •
In the summer of 2010, when we compiled the results of the previous year’s telephone surveys, we perked up. Beginning in 2007, we had included questions on sugary drinks on the surveys, and over the next two years the percent of New Yorkers who said they drank one or more a day dropped from 36 to 32 percent. That translated to a fall of more than 250,000 New Yorkers. Was it possible that the media a
ttention given to sugary drinks—not just our ads but also the fights over soda taxes—was persuading people to avoid soda?
We weren’t sure, but we decided to keep making noise. The early focus groups on sugary drinks had given advertising man Jose Bandujo another idea. “What are these grams that are on these cans and bottles?” he said. “Nobody knows what a gram of sugar is.” He decided to translate it into something people understood. When he did, his team was shocked.
They came up with two subway posters. One showed a 20-ounce bottle of soda, with the headline “YOU JUST ATE 16 PACKS OF SUGAR.” The other pictured a 32-ounce cup, with the words “your kid just ate 26 packs of sugar.” In both, sugar packs poured into the containers, which then overflowed with blubber.
That same summer employees of both Coke and Pepsi asked to meet with us. They wanted to tell us about work they were planning in the Bronx. It was New York City’s poorest borough and the county that routinely ranked last in the state in nearly every health statistic. People in the Bronx drank the most soda and were the most overweight.
The two soda companies’ campaigns were close cousins. Pepsi’s “Zero Calorie Bronx Test” meant pushing its diet brands, such as its new Pepsi Max, by putting more bottles on store shelves, installing special in-store display racks, distributing discount coupons, and running street “sampling” events with a truck labeled “Fantastico Sabor. No Incluye Calorias.” Coke’s “Bronx Pilot” tried to increase sales of its diet drink, especially Coke Zero, with billboards, in-store display racks and ads, meal tie-ins, coupons, bundles (“Buy three 2-liter bottles and get one 2-liter bottle free”), and a sampling truck emblazoned with “Real Coca-Cola Taste and Zero Calories.” Both companies also touted money they were giving to community groups: Pepsi was funding four churches to teach people to eat fruits and vegetables, and Coke was giving grants to schools for exercise programs that reached a few hundred children.
