Big Soda Bullying Backfires Sodas Health Officials Duke

Big Soda Bullying Backfires "Sodas, Health Officials Duke It Out City by City" WSJ Sept. 3, 2015 Thomas Schlenker, MD, MPH APHA Chicago 2015

Presenter Disclosures Thomas Schlenker, MD, MPH (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Employed since October 1, 2015 as Medical Director of Interlex a national causebased communications and marketing agency.

Obesity* Trends US Adults Behavioral Risk Factor Statistical Survey (BRFSS), 2010 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%– 14% 15%– 19% 20%– 24% 25%– 29% ≥ 30%

Sugary Drinks and Obesity Fact Sheet, 2014 Harvard School of Public Health www. hsph. harvard. edu/nutritionsource • “In the 1970 s, sugary drinks made up about 4% of the US daily calorie intake; by 2001, that had risen to 9%” • “Sugary drinks(soda, energy, sports drinks) are the top calorie source in teens diet, beating out pizza. ” • “Beverage companies in the US spent roughly $3. 2 billion marketing carbonated beverages in 2006, with nearly a half billion dollars of that marketing aimed directly at youth ages 217. ” US Federal Trade Commission

Local Data Make It Real

Diagnosed: 159, 650 people or (13%) have Diabetes Undiagnosed: 61, 404 people or 5% In Bexar County Prediabetes: 405, 266 people or 33% Obesity at risk: 330, 572 people or 28. 5% of Population Communities Putting Prevention to Work using Behavioral Risk Factor Surveillance, Bexar county 2012

Change in Obesity and Obesity Risk Factors Bexar County 2010 - 2012 Population Characteristics 2010 Obesity ( ≥ 30 BMI ) 2012 Obesity ( ≥ 30 BMI) Proportionate Change Obesity Total 35. 1% 28. 5% -19% Females 35. 4% 28. 3% -20% Males 34. 9% 28. 7% -18% 40. 5% 29. 6% -27% 29. 3% 36. 1% +23% 31. 5% 41. 9% +33% Hispanic/African American Obesity Risk Factors Regular Soda (none per day) Females Source: Communities Putting Prevention to Work –Behavior Risk Factor Surveillance Survey 2010 and 2012 Males 27. 1% 29. 9% Sugar Drinks (none per 35. 4% 34. 6% +10% NS 8

Diabetic Amputation Rate by Zip Code, Bexar County, 2011 Rate per 1, 000 Diabetic Inpatients Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas 49. 7 43. 8 38. 0 30 to to 68. 8 49. 6 43. 7 37. 9

Diabetic Amputations by Zip Code, Bexar County, 2011 Number of Diabetic Amputations per Zip Code Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas 67 to 29 to 11 to 0 to 111 66 28 12

Diabetic Amputation Rate: Highest in Texas/3 Times US National Average County Dx of Rate per Diabetics Rate per Name Population Diabetics 1, 000 Amputations 1, 000 Harris 4, 180, 894 83, 057 19. 9 2, 338 28. 1 Dallas 2, 416, 014 52, 453 21. 7 1, 693 32. 3 Tarrant 1, 849, 815 40, 123 21. 7 1, 156 28. 8 Bexar 1, 756, 153 46, 007 26. 2 1, 944 42. 3 Travis 1, 063, 130 17, 498 16. 5 553 31. 6 El Paso 820, 790 18, 653 22. 7 620 33. 2 Collin 812, 226 11, 418 14. 1 297 26. 0 Hidalgo 797, 810 21, 686 27. 2 597 27. 5 Denton 686, 406 10, 287 15. 0 284 27. 6 Fort Bend 606, 953 7, 975 13. 1 233 29. 2 Total 25, 674, 681 588, 971 22. 9 18, 157 30. 8 Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas 7

City of San Antonio Community Survey 2014

Focus Makes It Effective

Why focus on sugary drinks? • • Because sugary drink consumption and obesity are strongly linked Because cutting back is the logical first step for the majority of our community

Why focus on soda? • Because 80, 000 San Antonians have already broken the every day soda habit. Si se puede! • Because not drinking soda every day is a measurable road to success.

But. . . Big Soda Fights Back • • • Creating Doubt Offering Collaboration Obstructing “Philanthropy” Direct Action

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“The people who make up America’s beverage companies have a long history of engaging in thoughtful discussions and meaningful actions to address the public health issues of overweight and obesity…And, we are always interested in new opportunities to make more meaningful changes to improve public health. We welcome discussions with anyone from government, academia or non-profits who are willing to partner and make a difference together. ” American Beverage Association statement in response to Diane Rehm NPR interview with Marion Nestle “Soda Politics: Taking of Big Soda (And Winning)” Oct. 8, 2015

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Local Contex/Institutions Makes It Sustainable

Why does it matter in South Texas? – “Educated, affluent Americans are drinking less soda today then they were a few years ago and soft drink companies are now targeting minorities and children. Most disturbingly, younger Hispanics face higher rates of developing diabetes than any other group. ” » Jill Filipovic, The Guardian. 2 -3 -2014