Wednesday, January 30, 2013

Banning Large Sodas to Decrease Obesity- A Critique on New York Soda Ban- Disha Shah

Banning Large Sodas to Decrease Obesity- A Critique on New York Soda Ban- Disha Shah
Obesity is one of the most daunting challenges for the public health, worldwide. Obesity rates in the United States are among the highest in the world. According to CDC, during the past 2 decades, there has been a dramatic increase in the obesity trend in the United States. More than one-third of U.S. adults (35.7%) and approximately 17% of children and adolescents aged 2—19 years are obese.1
The prevalence of obesity in New York State is 24.5%.2 As a step to control obesity, Mayor Bloomberg imposed a ban on super-sized sugary beverages larger than 16oz in public places such as restaurants, food carts, movie theatres, and delis. The ban won’t impact fruit juices, milkshakes, diet sodas or alcoholic drinks.3 Enforcement would be conducted by an existing corps of city restaurant inspectors. A violation of the law would lead to a $200 fine. This type of ban is first of its kind, and is becoming a growing national debate. The city pioneered in banning trans-fats, and it subsidizes fruits and vegetables for the poor through its Health Bucks  program.5 The intention behind this soda ban is to cut the intake of excessive calories from the large sized soda, thus to control obesity. Thomas Farley, commissioner of New York City’s Health Department, writes that if the new regulation “leads to New Yorkers simply reducing the size of one sugary drink from 20 ounces to 16 ounces every other week, it would help them avoid gaining some 2.3 million pounds a year.”Thomas Farley may be right here, but there are so many alternatives to a supersized soda, which might be responsible for obesity, and which are not addressed by this ban.

1.      Does Not Create a Sense of Perceived Susceptibility:
To start with the flaws, the proposed ban on large, sugary drinks actually is not really a ban on anything. According to the ban, people will not get the choice of drinks larger 16oz. A large drink of soda (34 oz.) has about 108g of sugar.4   A small sized drink (16 oz.) has about 39g of sugar. People still aren’t completely prevented from drinking soda. It doesn’t cover beverages sold in supermarkets or most convenience stores (which are not regulated by the city). Drinks are also exempt if they contain more than 50 percent milk (so people are permitted to have a large Frappuccino with whole milk and sugar, which might contain more calories than a large soda). Alcoholic beverages are not included in the ban as well. "This is the largest single driver of the obesity epidemic," said Dr. Thomas Farley, health commissioner of the city. "It is the largest source of added sugars to our diet."6 So what about the sugar content in 16 oz. drinks? Is it safe to consume 16 oz. soda? Or is it safe to have 2-3 donuts on a daily basis? So looking to all these aspects, the ban on large drinks is not a ban at all. According to Health Belief Model, perceived susceptibility, also called perceived vulnerability, refers to one's perception of the risk or the chances of contracting a health disease or condition.9 One of the important determinants is whether or not a person believes that the problem could happen to him or her. If people think that they cannot get a particular disease or have a particular problem, they often will not take an action to prevent it. By imposing a ban on large drinks, people are not informed about the harmful effects of the smaller portions of drinks which can be equally responsible to be one of the factors contributing to obesity. Also, other high calorie food are not being identified as risk factors and people are not made to understand that they are susceptible to obesity if they drink ‘soda’ and not if they drink ‘large soda’.
2.     Invokes Psychological Reactance:
Psychological reactance is an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy.10 Psychological reactance occurs in response to threats to perceived behavioral freedoms. If a person’s behavioral freedom is reduced or threatened, the person will become motivationally aroused. Because of the fear of losing the freedom of that particular behavior, they get motivated to restore their freedom, by doing exactly opposite of what is desired. This brings them a sense of ‘re-establishing’ their freedom and regaining back the control of their lives.13 This ‘boomerang effect’ is psychological reactance.
According to the above explanation for invoking reactance in the masses, it can be concluded that this policy has all the ingredients to invoke the reactance in the target population. 6 in 10 New York residents were in opposition of this ban.11
This policy is actually not a ban, just a cap on large sodas. But it has been framed as a ‘ban’. This is one of the factors giving rise to ‘liberty issues’ and ‘freedom to choice’ in the target population. The soda companies will be affected directly by this policy. The American Beverage Association, whose members could stand to lose millions of dollars in revenue if the mayor’s plan is approved, has argued that there is little correlation between soft drinks and obesity. The industry group has led a big-budget public-relations effort urging New Yorkers to “make their own choices” on soda. These commercials are being aired on local television and radio. This has added to contribute in the psychological reactance.
Many researches show that when people are restricted or told to exhibit certain behavior, they choose to do exactly the opposite of what they are being told.12
This is one of the major flaws of this intervention. It completely violates the psychological reactance theory. “I know what’s best for you” kind of attitude has created an image of ‘nanny Bloomberg’.14
In general, policy makers should be aware of reactance and should recognize that individuals may respond in a counterproductive manner to policies that appear to threaten their ability to choose freely.
3.     Violates the Social Cognition Theory
According to social cognition theory, self efficacy and environmental factors play an important role in determining whether a person will change health behavior. In this case, environmental factors are not in favor of the desired behavior. The change does not make a favorable environment for the public to show the desired behavior. It's important to look at where people acquire such large drinks. An average New Yorker does not go to a movie theatre often, and attends sports venues even less regularly. In fact going to a grocery or a convenient store are much more common occurrences. So there is every possibility of the city resident buying his/her drink from such stores and gulp as much as soda he/she wants relaxing at home. The ban does not consider the complexity of how and why people acquire food and drink, and instead applies a simplified solution to a layered problem. It does nothing to do the self efficacy of the people or does not consider creating a ‘healthy’ environment. Thus, it is likely, that the desired behavior cannot be obtained in the target population. Self efficacy which means strong intention, knowledge and skills to carry out likely behavior is a strong determinant of human behavior. This behavior is reinforced when there are no or very less environmental constraints and rewards for change in behavior. By introducing ban, the self efficacy of the people is being questioned. ‘Ban’ seems to be more like an enforcement, which in social sciences can be called a ‘punishment’ without obvious rewards. Punishment is less effective than reinforcement for teaching and modifying behavior.8 Moreover this policy fails to reach at the core of the issue by not being able to change core belief of the target population. They are not able to achieve this because still there are plenty of catchy advertisement floating all over media which lure them to buying more and more of unhealthy drink. Have they been able to add a knowledge element simultaneously such as making it compulsory to show that drink consumed in large portions is harmful to health just like it is mentioned on the cigarette packs. Therefore, it is pretty much less likely to impact New Yorkers in reducing obesity. On the contrary ban portrays something which restricts freedom and people tend to believe that their choices are controlled by higher authority and this will cause fewer acceptances and eventually will not modify behavior which is primary goal for introducing this policy.

Articles published in some of the medical journals suggest that rising levels of obesity may be linked to increases in soft drink portion sizes; this implies that reducing the consumption of sugary beverages may lead to better health outcomes.  However, the manner in which Mayor Bloomberg is attempting to achieve this goal ignores a number of important insights from behavioral science. It stimulates rebellion and distrust with elected officials. If we want people to drink less soda then we have to make people not want it and not telling them that they can’t have it.

Counter-proposals for the critiques:
1.      Counter-proposal for critique 1:
As stated in critique 1, a state of perceived susceptibility is not being demonstrated by this policy. There have been researches conducted which demonstrate that perceived susceptibility leads to a desired behavior.15
To develop a perceived susceptibility amongst people regarding the fact, that high calorie drinks such as soda, can lead to obesity, number of things can be done. One way is to create a graphic warning (and not verbal message) on the soda cups. For example, the large cups of soda should portray a fat, obese family with a sad pictorial representation of heart. And on small cups, a slim, healthy family with a smiling heart.  In this way, the message can be conveyed implicitly and obesity can be projected as a ‘cardio-vascular hazard’ and not just ‘being fat’.
 This can be mandated to all the large sized high-calorie drinks and not just soda. Thus, it will be considering for all the drinks which contribute to obesity and not just soda. Pictures can help to increase the message’s accessibility by people with low levels of literacy and can help visualize the actual message to be conveyed. Color pictures can be used to make it more effective and attractive.
These types of graphic warnings are made mandatory on the cigarette packs. Researchers have shown that these warnings are actually effective to decrease the rates of smoking.16
2.     Counter-proposal for critique 2:
As stated in critique 2, a ‘ban’ can induce a reactance in the target population, even though it is not ban but just a cap. There are many possible actions which can be taken to decrease the reactance. One simplest way is taxation on the sugary beverages. This type of ‘soda tax’ has already been imposed in certain states in US and has been effective.17 Such tax can be imposed on all high calorie drinks and not just soda. Another option is increasing the price of drinks and discontinuing the increase volume discounts.
Along with this, messages should be effectively conveyed with the help of popular celebrities regarding relation between high calorie diet and obesity. The media and especially actors and actresses have a huge influence on today’s youth. If these celebrities are sought to educate the masses what is right for their health, it will have a much higher impact and will be acceptable as they are not forced but are shown a direction towards healthy living from their role model.
Simultaneous implementation of these steps may lead to decrease the psychological reactance as well as see the desired behavior.
3.     Counter-proposal for critique 3:
Self efficacy and environmental factors play an important role in determining behaviors of the population. So it is very important to look at the issues pertaining to the self efficacy and environmental factors when planning to change the behavior of the populations. Here the word ‘ban’ causes havoc as it is in direct conflict to the behavior we want to achieve. This causes negative reinforcement as it tend to make people think that they are being controlled and they do not have right to choose what they want. Instead of banning the choices that people want, one should focus on adding a knowledge element so that it can help people make better choices. Environmental factors can be controlled by imposing a soda tax. So, people have to pay more at all the places from where they can get a soda, and not just movie theatres or a restaurant.
Regarding self efficacy, it has been found that self efficacy operates best in concert with general life style changes, including physical exercise and provision of social support. Self-confident clients of intervention programs were less likely to relapse to their previous unhealthy diet. Chambliss and Murray (1979) found that overweight individuals were most responsive to behavioral treatment where they had a high sense of efficacy and an internal locus of control. Other studies on weight control have been published by Bagozzi and Warshaw (1990) and Sallis, Pinski, Grossman, Patterson and Nader (1988).18  Self efficacy can be increased by increasing  self-confidence of the people. One way to do this is to start a campaign named “I can do it by myself!” Through such campaigns, the obese and over-weight people can be motivated to reduce their weight and improve their life style by giving them real life examples from people who have been successful in doing so. Also, the people who achieve their goals can be rewarded (like replacing the previous people in the campaign commercials). This can act as a positive reinforcement.
Exercise should be made a part of school curriculum. It should be made compulsory in every school for the students to take part in any form of exercise, such as yoga, dance, or other gymnastics. This way, we can make them efficient to live a healthy life style from their childhood.
Thus, it should be our fight against “obesity” and not “soda consumption”.


1.       Obesity and Overweight for Professionals: Data and Statistics: Facts - DNPAO - CDC. (n.d.).Centers for Disease Control and Prevention. Retrieved from

2.      Obesity and Overweight for Professionals: Data and Statistics: Adult Obesity - DNPAO - CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved from

3.      N. (2012, September 14). Why Soda Ban Will Work In Fight Against Obesity; Food Regulations Have Proven Record. Forbes.

4.      How Much Sugar in Sodas and Beverages? (n.d.). Sugar Stacks - How Much Sugar Is in That?. Retrieved from

5.      D. (n.d.). New York City looks out for health of its own; It's a shame the notion that governments should promote well-being is so derided. newsday.

6.      Large-size soda pop likely to be banned in NYC. (n.d.). korea times.

7.      New Yorkers for Beverage Choices | The Facts. (n.d.). New Yorkers for Beverage Choices. Retrieved from

8.      Leach, D. (n.d.). Using Positive Reinforcement to Increase Desired Behaviors | Butterfly Effects. Retrieved from

9.      Theories and Approaches. (n.d.). Retrieved from

10.   Psychological reactance theory Psychlopedia (n.d.). Retrieved from

11.    Grynbaum, M. (2012, August 22). 60% in City Oppose Bloomberg’s Soda Ban, Poll Finds. the new york times.
12.   Abel , Barksdale. (2012). Freedom of choice and adherence to the health regimen for african americans with hypertension. Ans Adv nurs sci. Retrieved from

13.   Quick BL, Bates BR. (2010). The use of gain- or loss-frame messages and efficacy appeals to dissuade excessive alcohol consumption among college students: a test of psychological reactance theory. J Health Commun. Retrieved from

14.   'Nanny Bloomberg' Ad In New York Times Targets N.Y. Mayor's Anti-Soda Crusade. (2012, June 4). Huffington post. Retrieved from

15.   Rahman M, Berenson AB, Herrera S. (2012). Perceived susceptibility to pregnancy and its association with safer sex, contraceptive adherence and subsequent pregnancy among adolescent and young adult women. Retrieved from


17.   Why Mike Bloomberg’s 'Soda Ban' Could Actually Work. (2012, September 14). the daily beast. Retrieved from

18.   Ralf Schwarzer & Reinhard Fuchs (n.d.). Self-Efficacy and Health Behaviours. Userpage < ZEDAT < ZEDAT - Hochschulrechenzentrum. Retrieved from

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