by Tom Farley
Mayor Bloomberg went on the national media outlets. “Obesity is the only public health issue in this country that’s getting worse,” he said on NBC. On ABC, he pointed to a “medium”-size cup and told Diane Sawyer, “That was the size of the popcorn I used to get, not the drink.” In turn, she asked him about the nicknames “Nanny Mike” and “Soda Scrooge.” I took the local television interviews. As I was waiting to go on one morning show, I overheard two employees talking about the rule. One liked the “soda ban” because “people are idiots.” Her co-worker apparently disagreed; she followed by asking, without a trace of embarrassment, “How do you get through a whole movie?”
The aftershocks rumbled for days. The papers did man-on-the-street stories. Editorial boards and columnists weighed in: the Times editors hated it (“a ban too far” and “too much nannying”) and foodie columnist Mark Bittman loved it (sodas are “not food”). On the popular daytime talk show The View, Barbara Walters weighed in for it and Whoopi Goldberg against. The late-night comics reveled in it. Stephen Colbert carried out an Of Mice and Men–like mercy killing of a five-foot-tall “Drinkee.” Jon Stewart hammered on the subject for days, yelling that the rule “combines the draconian government overreach that people love with the lack of results that they expect!” The stories bounced around the globe. A friend of mine, traveling in a small city in Indonesia, was told, “I hear that your mayor wants to ban soda!”
The mayoral candidates were forced to take sides. Christine Quinn came out against the rule, as did rivals Bill Thompson and John Liu. Manhattan borough president Scott Stringer declared in favor. Bill de Blasio, then the public advocate, called me with a few staff on the line and, after probing with a few careful questions, announced for the rule.
Pollsters took the city’s pulse. One found that, instead of showing the 60 percent support we had gotten for “limiting the size of sugar-sweetened drinks” on an earlier survey, New Yorkers opposed the “soda ban” by 51 to 46 percent.
Howard Wolfson led the charge to get our side of the story in the press. Staff from City Hall and the health department drummed up dozens of approving statements—from people as wide-ranging as Alec Baldwin, Bill Clinton, and Judy Collins—and e-mailed them to reporters daily. The press team organized media events, each with its own message. In one, Mayor Bloomberg was flanked by a pack of white-coated doctors to ring alarms about the crisis of obesity and diabetes in the Bronx. In another, the mayor brandished an endorsement by Weight Watchers to show that the rule would help the millions of New Yorkers struggling to lose weight.
Too often, though, we played defense. Weren’t we interfering with personal freedoms? The truth, which rarely came through, was that customers already had no choice in soda sizes. No one could buy an 8-ounce cup of soda at McDonald’s. At some movie theaters in New York, the smallest size drink for sale was a quart. Someone other than the customer was deciding what size cups to stock, and that someone worked for a corporation that only wanted to sell more soda.
In the tobacco policy battles, Tom Frieden had gone on offense, attacking the tobacco companies as greedy murderers. But Wolfson—reflecting Bloomberg’s sentiments—held firm that we would not attack the soda companies. We had no beef with Coke or Pepsi. We were doing this only because portion sizes had gotten out of hand and we had an obligation to answer a health crisis.
We had caught the soda companies by surprise, but after a pause they hit back hard. Their PR firm created a new front group called New Yorkers for Beverage Choices, which put billboards on the backs of soda delivery trucks, with an athletic figure in silhouette defiantly raising a large cup, next to the words “DON’T LET BUREAUCRATS TELL YOU WHAT SIZE BEVERAGE TO BUY.” They ran radio spots with “Noo Yawk”–accented actors saying “This is about protecting our freedom of choice,” and video ads asking “Are we gonna let the mayor tell us what size beverage to buy? If we let ’em get away with this, where will it end?” They flew banners attacking the rule from airplanes over Coney Island.
They mailed letters to hundreds of thousands of New Yorkers, asking them to sign and return enclosed cards opposing our rule. They organized a “Million Big Gulp March” on City Hall steps, attended by some fifty people, many wearing matching T-shirts saying “I PICKED OUT MY BEVERAGE ALL BY MYSELF.” There, under a banner showing a Statue of Liberty–like figure, City Council members and a Teamsters leader rallied the group with words like tyranny and freedom. For all that, Howard Wolfson thought it could have been worse. “Look, they didn’t run TV ads,” he said later. “These are companies that are worth many, many billions of dollars.”
Five days after the story broke, I testified to City Council at what was supposed to be a routine budget hearing and was pummeled by council members. One complained about the portion rule’s “arbitrariness” because we hadn’t regulated the sizes of candy bars or beer. Another council member called the “piecemeal” policy “insulting to our intelligence” because it didn’t address French fries and hamburgers. A third member, sitting behind a large soda cup, called the rule unfair because “90 percent” of the parents who go to movie theaters buy one large sugary drink and share it to “feed their families” while saving costs. After the hearing, as the council members filed out, they were warmly greeted by the lobbyist for Coca-Cola.
When we tried to rally supporters, we saw how deeply embedded the soda companies are in our society. One obesity researcher whose support we solicited turned us down because she believed her endorsement might jeopardize her ability to get grants. The head of a health insurance company, which would benefit financially if people stayed healthy, told me that he couldn’t support the portion rule because he would “catch hell” from his clients, the bottling companies.
Inside the health department, my team was actually heartened by the soda companies’ nuclear response. Susan Kansagra said later, “We knew they were out there, they were probably spending a lot of money, and we felt that was good because that meant they were really scared about the impact of this proposal.” Maybe their overreaction really did mean that we had hit on a great idea. But with all their firepower, it also meant that they might win.
• • •
The Board of Health meeting on Tuesday, June 12, was scheduled to start at ten a.m., but the media trucks began arriving in front of the health department’s new building in Queens at five. The meeting room was sterile, long and narrow, and had a glass wall on the long side, so onlookers in the hallway could watch the board members as if they were in a large fishtank. That day the members sat behind folding tables arranged in an L shape, some alongside and some facing a space set aside for the cameras. The photographers spilled beyond the space, though, with some lying on the floor and others peeking their lenses over the shoulders of competitors. The rest of the room was filled with rows of chairs packed with print reporters, people in dark suits who looked like lawyers or lobbyists, and health department staff.
The soda companies and the press assumed that the board was a rubber stamp for the mayor, but the members were in fact independent health experts. They were appointed by the mayor but confirmed by the City Council; they served fixed six-year terms and could be removed only based on proof of misconduct or inability to function. Of the eleven board members, seven were doctors, three were health care managers, and one was a professor of public health. None knew Bloomberg personally, were part of any political organization, or had any political ambitions. The board rarely rejected a proposed rule from the health department, but after seeing how affected people or businesses reacted to a rule during the required public comment period, they or the health department often altered the rule.
A law prevented board members from conversing about proposed rules outside open meetings, and Tom Merrill always insisted that we scrupulously obey. A week before the meeting, we had sent the members the portion rule and a memo explaining the reasoning behind it. Other than that, until the meeting, the board members knew only what they had seen in the press. I had
no idea how they would react.
Susan Kansagra sat facing them at the witness table, with Maura Kennelly at her side, looking small and a little nervous. After she summarized the rule and its rationale, showing slides on the video screens wrapping around the long room, board members took turns asking polite questions. They wanted to understand the 16-ounce cutoff, how the rule would handle ice in a cup, and diet drinks. Bruce Vladeck, a gruff health care systems consultant who once ran the federal Health Care Financing Administration, asked about capping portion sizes for popcorn at movie theaters. Deepu Gowda, an earnest young internist from Columbia University, asked about taxing soda instead. Mike Phillips, a public health physician from New York University, sounded skeptical. He asked what was unique about sugary drinks. What about hamburgers and French fries—hadn’t their portion sizes grown too? And why didn’t the rule apply to convenience stores? When Kansagra explained why, he asked politely, “Is that fair?”
Only one board member, Brooklyn primary care doctor Sixto Caro, seemed clearly against the rule. He worried out loud that it would somehow increase taxes for small businesses. “When a consumer buys 16 ounces, they pay 8.25 percent. If they buy a second one, they pay more taxes. And the small business has to pay those taxes. . . . Why are we targeting the low-income small businesses instead of the big companies?” But at the end of the questioning, the board voted unanimously to publish the rule for public comment.
• • •
The day before the board meeting, Coca-Cola CEO Muhtar Kent had asked Bloomberg to meet. Three days later he flew to New York City with Steven Cahillane, the CEO of Coca-Cola Refreshments, its North American bottling company, and two others. Howard Wolfson, Linda Gibbs, and I joined the mayor to meet them at the dining room table at Gracie Mansion, over a linen tablecloth and cans of Coke Zero.
Kent, the son of a Turkish consul-general who was born in New York City, has a broad chest, impeccable grooming, an accent that reflects his British education, and a big winning smile. After chatting for ten minutes with Bloomberg about the depression and the teetering financial system in Europe, he made his case. “We are a marketing company and a hydration company,” he said. “We are not perfect,” but his company was trying to do its part to solve the obesity problem. It was “not an accident” that sales of diet beverages had risen to 30 percent of the market. Now, though, our rule was killing them. He had just come from Europe, where everyone was saying, “‘I hear Mayor Bloomberg is banning your product in New York City.’ Even though we know that’s not exactly what you are proposing, that is the perception.” To have this iconic product, the global symbol of America, banned by the city that is the symbol of America was ruining its image. Instead of fighting each other, we should work together, he said. We could accomplish so much more if we did—Coke with its ability to influence the consumer and Mayor Bloomberg with his global reputation in health.
Cahillane, the son of a New York firefighter with roots in Ireland, had a thin face, sandy hair, and an appealing directness about him. He was a manager who had worked his way up through the beer business. Coke had done a pilot project in the Bronx, he said, that had led to a 10 percent increase in the sales of diet beverages and a 2.5 percent decrease in the sales of full-calorie sodas. That showed what they could do.
Kent proposed to take the Bronx pilot project citywide if we agreed to withdraw the rule for a year. It would have a greater impact on calorie consumption in New York City, he said, than our rule would. Dr. Farley could model the impact to verify that that was true, he said, opening his arms to show that he had nothing to hide. And he was sure that if we agreed, he could bring Pepsi along with the plan.
It was the only time I ever saw Mike Bloomberg look uncomfortable. He was a businessman before he was mayor, and he didn’t like opposing another businessman. He was concerned about obesity, he said. But two people on the Coke board had already spoken to him about this. He wanted to work with Coke. And then he asked Howard Wolfson to follow up on Coke’s offer.
That set off some frantic negotiations. Cahillane came back to New York a few days later with a concrete proposal. Coke would ramp up its promotion of diet products in grocery and convenience stores, introduce smaller bottles and cans in groceries (without eliminating the larger sizes), introduce 12-ounce cup sizes in restaurants that didn’t already offer them, and replace some of the full-calorie options on restaurant soda fountains with diet sodas. Over the next three years, he claimed, that would lead to a 12 percent reduction in the calories that New Yorkers got from sugary drinks. And he would throw in funding to support a few physical activity programs.
After spending some hours with spreadsheets, I was convinced that Cahillane’s proposal actually had the potential to cut sugary drink consumption substantially. It was tempting to consider a big agreement using the power of Coca-Cola to reduce sugary drink consumption. But the Coke people knew so much more about the business than we did. I was worried that we could be hoodwinked.
I wrote my own balance sheet. On the plus side, Coke’s offer would affect more distribution channels than our policy, which affected restaurants only. The city might indeed see a health benefit, and the political pressure and the press noise would disappear.
But the minus side was long. Coke would have to get the other soda companies to agree. Coke hadn’t shown us any hard data from its Bronx pilot or offered any numbers to measure progress. We would be completely dependent on the corporation’s actions, with no way to verify what it was doing. In another eighteen months, we would be out of power; if Coke’s plan was going off track, even if we knew it, we’d be helpless. Most of the changes the company proposed were ones that it was already making in response to public pressure on obesity—or should have been making. And dropping our rule would eliminate, probably forever, the policy tool of limiting portion sizes as a way of fighting obesity.
I went through my thinking with Howard Wolfson and Linda Gibbs. Then we got back together with Cahillane and tried to discuss other portion-reducing possibilities, but the conversation quickly went downhill. Cahillane complained that soda was only a tiny part of the diet, and that we were only going after Coke because it was such a high-profile target. I disagreed; we were attacking soda (not just Coke) because of studies linking it to the massive obesity epidemic. Without getting rid of large portion sizes, I said, there was no guarantee that we would ever see a fall in consumption. Coke couldn’t possibly take away any portion sizes, Cahillane said, because that implied “Coke is bad.” If we didn’t accept this offer, he would take it to another city, which would reap the benefits that New York City had turned down, and Coke would fight the portion rule tooth and nail.
17
“The NSRI’s success is far from guaranteed.”
On February 11, 2013, I stood in City Hall’s ornate Outer Ceremonial Room with representatives of seven food companies, waiting for Mayor Bloomberg. It was the same room in which we had gathered three years earlier to unveil the companies’ promises to cut salt in their food. Now we would cheer what they had achieved.
But I wasn’t sure whether we could call the entire project a success. After the launch in early 2010, we had hoped a swell of other companies would join the parade, but only a few had done so. It wasn’t clear if enough companies had enlisted to make a meaningful difference. In 2012 the Center for Science in the Public Interest checked the nutrition labels of 480 packaged and restaurant foods, comparing the sodium content in 2011 to that of 2005. Sodium levels had fallen in 43 percent of food items and risen in 33 percent. On average, they fell by 3.5 percent in packaged foods but rose by 2.6 percent in restaurant foods.
It was still early, but that hardly felt like a victory. By the fall of 2012, most of the food industry seemed to have realized it could safely ignore us. Sonia Angell and I wrote a paper in the American Journal of Public Health trying to warn the companies that by doing nothing they risked a heavier government hand. “The NSRI’s success is far from guaranteed,” we wrote.
“It is unlikely that the current number of company commitments will substantially alter the sodium composition of our nation’s food supply. . . . If this process does not lead to meaningful industry-wide reductions, it justifies the call for regulation recommended by the IOM committee.”
Just as this article appeared, though, Christine Curtis was reviewing the first reports from the companies that had signed on. After she verified the data, “we were really excited.” Twenty-one of the twenty-four companies that had publicly promised to lower sodium by 2012 had met their targets. They had done what many other food companies had said was impossible, and they had done it quickly.
Curtis noticed something else exciting. She and her staff labored for many long hours updating their food databases with nutrition data. As they typed numbers into their computers, they noted that some companies that had spurned the NSRI were nonetheless reporting lower sodium levels. Apparently, while they had been afraid of making a public commitment, they had quietly made changes anyway.
The companies that had made public promises still deserved a public thanks. So I stood with representatives of Kraft, Mondelz (a global company that had split from Kraft), Mars, Goya, Subway, Fresh Direct (an online grocer), and LiDestri (a regional maker of pasta sauces). As we waited, we talked about salt. Because other food companies had complained so bitterly, I was curious about how the winners had pulled it off. The vice president for R&D at Kraft, talked excitedly about substituting potassium chloride for sodium chloride in a food laboratory, sometimes adding other ingredients to mask the potassium’s bitterness, and testing the changes to meet a taste profile. But a manager from Goya, a much smaller company that marketed products mainly to Hispanics, shrugged. Goya had just put less salt in the beans.
Then Bloomberg arrived. He thanked them all and led us to the Blue Room to face the cameras. “Today I’m pleased to announce that twenty-one major food companies have reached [our] 2012 sodium reduction goals,” he said. “This group is no small potatoes: it includes some of the biggest packaged food companies, restaurants, and food retailers in the country, if not the world. . . . The products they’re making healthier are some of America’s most beloved and iconic foods.”
