Sugar Drinks: Feeding San Antonio’s Obesity Epidemic

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From Director of San Antonio Metro Health Department Dr. Thomas Schlenker's presentation, "Obesity in San Antonio: Change in the Right Direction."

Then-director of Metro Health Dr. Thomas Schlenker presented "Obesity in San Antonio: Change in the Right Direction" to City Council on May 2014 and included this suggestion for messaging. His proposed campaign was rejected.

Dr. Thomas Schlenker has 40 years of experience as a practicing pediatrician and nationally-recognized public health official. As the Director of Health for the San Antonio Metropolitan Health District, he oversees a staff of 400 and is the city and county’s top public health official. Consider him San Antonio’s trusted family doctor.

Director of San Antonio Metro Health Department Dr. Thomas Schlenker

Director of San Antonio Metro Health Department Dr. Thomas Schlenker

On Wednesday he made an important house call, presenting an update to City Council on the city’s modest improvement in its adult and juvenile obesity rates, good news he packaged with a proposal to launch a major public education campaign linking consumption of sodas and other sugar-laden drinks to the city’s troubling obesity epidemic.

Schlenker’s presentation, titled, “Obesity in San Antonio: Change in the Right Direction,” put the best possible face on a city struggling to shake its dependency on heavily marketed soft drinks. The good news is the number of adults, especially women, drinking one or more soft drinks daily declined by several percentage points between 2010 and 2012.

A range of city initiatives, taken together as the federally funded Communities Putting Prevention to Work (CPPW), are clearly delivering positive results. Salad bars in public school cafeterias, B-Cycle, the city’s bike share program, greatly expanded outdoor amenities such as the Mission Reach, public recreational events such as Síclovía, and fitness classes in the parks, all have contributed to a positive trend line.

Obesity in San Antonio B session May 2014.001“Why focus on soda?” Schlenker asked rhetorically, noting that we live in a city also hooked on fatty, nutrition-deficient foods. “Because 80,000 San Antonians have broken the everyday soda habit, and ending the daily soda habit is the first step to a healthier lifestyle. You have to start somewhere.”

The bad news is that every day a majority of San Antonio’s population still drinks one or more sugar or sugar substitute drinks, the latter also contributing to the obesity epidemic, according to a growing body of science. Even with the improvements cited by Schlenker, San Antonio remains one of the most overweight and health-challenged cities in the nation.

“64 percent of the people who live in San Antonio drink soda every single day,” Schlenker said. “It’s not an accident. These soft drink companies spend more than $3 billion a year marketing these drinks in the U.S., much of it focused on youth.”

The local problem is also a national problem. Schlenker’s presentation included a U.S. map that showed a growing number of dark red states, including Texas and all of the Deep South, where more than 30 percent of the population is obese (see below).

“In 1990, that map would have been largely blue,” Schlenker said, noting that obesity nationwide had doubled in that time period.

Map courtesy of the CDC.

Map courtesy of the CDC.

Schlenker said the decline in “soft drink” consumption is most notable among educated people, which has prompted beverage corporations to focus marketing efforts on “poor people and minorities.”

Mayor Julián Castro

Mayor Julián Castro

Mayor Julián Castro praised Schlenker’s work and, citing his own decision five years ago as a newly-elected mayor to set a public example and swear off daily soft drinks, he supported Schlenker’s call for a well-funded, multi-year campaign to better educate San Antonians on the inks between sugar drinks and life-threatening health risks.

Noting that San Antonio would  not follow the example of New York City and institute outright bans of oversized sugar drinks, Castro supported an aggressive public outreach campaign.

“Too many of our people drink soda, overdrink soda, I did that,” the mayor said. “We also have a diabetes problem.”

Director of San Antonio Metro Health Department Dr. Thomas Schlenker's presentation, "Obesity in San Antonio: Change in the Right Direction."

From Director of San Antonio Metro Health Department Dr. Thomas Schlenker’s presentation, “Obesity in San Antonio: Change in the Right Direction.”

The ensuing conversation among council members might have sent Schlenker, an advocate for cycling, walking and a healthy, active lifestyle, to the nearest bar for something stronger than a cola.

Some council members supported Schlenker’s fact-based presentation and recommendations, but a number of council members seemed more focused on their own personal consumption habits and some oddly-stated concerns questioning the role of government in promoting public health.

Several objected to an artist’s humorous rendering of Rosie the Riveter crushing a soda can that Schlenker included in his presentation as an example of how to communicate a bold public message.

District 2 Councilwoman Ivy Taylor

District 2 Councilwoman Ivy Taylor

District 2 City Councilwoman Ivy Taylor, a leading candidate to become interim mayor after Mayor Castro resigns later this summer to join the Obama administration as the next Secretary of Housing & Urban Development, was the first to challenge Schlenker’s strategy to focus on reducing soda consumption.

Taylor spoke about a family member who had been diagnosed as pre-diabetic who does not drink sodas, but does have a diet of fatty food and does not exercise.

She also noted that earlier in the day she had shared lunch with a public school student she is mentoring who declined a salad and instead dined on refried beans and tostadas.

“We’re not against soda,” Schlenker countered. “We’re only against too much soda. How much soda is too much soda? Drinking soda every day is too much soda.”

District 9 Councilman Joe Krier

District 9 Councilman Joe Krier

District 9 City Councilman Joe Krier then questioned the role of city government in public health and anti-obesity campaigns.

“From my philosophical viewpoint, parents are the best judge of what their kids should do, what they should eat, what they should not eat,” Krier said, adding that he enjoys a sugar-free sports drink after his daily jog.

“I like a well-marbled steak, too,” Krier said. “Is it bad for me? Absolutely.” He then added his preference for Whataburger’s chicken sandwich.

Schlenker’s proposed campaign, Krier warned, might be the first step down a “slippery slope … I am unpersuaded, Dr. Schlenker, that by picking out this product (sodas) we are doing our community a service.”

Schlenker stood at the podium, patiently addressing each challenge.

“I am a physician,” he reminded council members, expressing his wish he had time to sit down with each Bexar County resident and work up a careful medical history and program for sustained health.

“This is a first step, and as a doctor I’d say getting fit is a long journey, but there has to be a first step, and for most people that first step is cutting out drinking soda every day,” Schlenker said.

District 7 Councilman Cris Medina

District 7 Councilman Cris Medina

District 7 Councilman Chris Medina noted his own fondness for a Red Bull on Sundays and questi0ned Schlenker’s focus on sodas rather than a more comprehensive public message about the value of good diet and exercise. Why not advocate for drinking water instead of focusing on sodas, Medina asked. weet tea is just as bad as soda, he noted, saying Schlenker’s proposed campaign suggested “soda is the culprit of all things bad.”

“We’ve been telling people to drink eight glasses of water for 50 years and in that time we’ve gotten fatter and fatter,” Schlenker said, spreading his arms in frustration. “Drinking soda every day is strongly associated with obesity. We have to focus on a simple and direct message to stop that bad habit.”

A three-year, sustained campaign, Schlenker said, could mean that by 2017 “we would be living in a dramatically different community.”

From Director of San Antonio Metro Health Department Dr. Thomas Schlenker's presentation, "Obesity in San Antonio: Change in the Right Direction."

From Director of San Antonio Metro Health Department Dr. Thomas Schlenker’s presentation, “Obesity in San Antonio: Change in the Right Direction.”

District 4 Councilman Rey Saldaña.

District 4 Councilman Rey Saldaña

District Three Councilman Rey Saldaña then injected a note of realism to the conversation, asking Schlenker how many years of experience he had as a medical professional.

When Schlenker answered by saying “40 years,” the 27-year-old Saldaña, a former Stanford University varsity baseball player, noted his own rejection of soft drinks years earlier and said he would defer to Schlenker’s expertise.

“Seems like the numbers are decreasing but we’re still the most obese city in the country,” said District 5 City Councilwoman Shirley Gonzales, also an avid cyclist. “How does that work?”

“We are going in the right direction, but when compared to others cities in the U.S. we don’t come off so well,” Schlenker said. “Yes, we’re making progress, but we have a long, long ways to go.”

District 5 Councilwoman Shirley Gonzales

District 5 Councilwoman Shirley Gonzales

Gonzales noted that she lives two blocks away from the University Health System’s Texas Diabetes Institute on Zarzamora Street on the Westside, one of the nation’s largest diabetes treatment and research facilities, an unfortunate reflection of San Antonio’s epidemic levels of Type II diabetes, which plagues minority populations and is preventable with proper diet and exercise.

Visitors to the institute, both Schlenker and Gonzales noted, witness mostly minority patients whose bad dietary practices have led to amputations, blindness and kidney failure.

District 3 Councilwoman Rebecca J. Viagran

District 3 Councilwoman Rebecca J. Viagran.

District 3 City Councilwoman Rebecca Viagran joined Gonzales in remarks that suggested many parents might not be the best judge of  what’s best for their own children. She talked about witnessing relatives giving their two-year-old child Red Bull “juice” in his “sippy cup.”

In response to a question from District 8 City Councilman Ron Nirenberg, Schlenker said that San Antonio appears to be the first major city reporting a decline in its obesity rate to the Atlanta-based Centers for Disease Control.

“That sounds like headline to me,” Nirenberg said, a broadcast executive who noted that earlier in his working career he counseled people on fitness and wellness. “We probably ought to send a memo to Charles Barkley.”

District 8 Councilman Ron Nirenberg

District 8 Councilman Ron Nirenberg

Nirenberg supported a public education campaign, but urged Schlenker to partner with beverage companies to send a message supporting sensible consumption versus excessive consumption of sodas.

Earlier in the council session, District 1 City Councilman Diego Bernal had taken some ribbing for adopting better personal dietary practices as a result of the city’s SA2020 initiative and its focus on improved public health.

District 1 Councilman Diego Bernal

District 1 Councilman Diego Bernal

“As someone who has diabetes running rampant throughout his family, I get it,” Bernal said, supporting Schlenker. “We have an opportunity to do something larger and more thoughtful here.”

Mayor Castro, whose remarks Wednesday reflected his sense that his time as mayor will be drawing to a close over the summer, seemed to leverage his strong majority support on the council to urge support for a robust public education campaign focused on reducing soda consumption once more planning and research is completed. That would include seeking funding from local businesses, foundations and philanthropists.

“There is a tremendous distinction between bans and education campaigns,” Castro noted. “I do think it has to be specific and not overly broad. I do hope San Antonio will move forward with a  campaign  to reduce soda consumption.”

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15 thoughts on “Sugar Drinks: Feeding San Antonio’s Obesity Epidemic

  1. Soda is an addiction. Unfit people already know its bad for them but they can’t stop. I used to have a problem with those mexican cokes. I loved the feel of the bottle in my hand. I loved the head rush of that first icy cold sip. I’d drink at least 2 a day, usually more. For a long time I tried to cut back but would end up binging on many bottles at once if I stopped for too long. I would get cravings where I wanted nothing else in the world but another bottle. The only solution was to completely stop drinking them. Its been a few years since I’ve had one and I don’t get cravings anymore and my body is in better shape than ever before.

  2. what happened to Rosie the Riveter’s bulging bicep??? She looks like she couldn’t crush a can in this rendering. Sodas are also bad for your teeth, and full of corn syrup. The push back against a medical professional by council members is interesting, I guess they trust their feelings more than facts.

  3. With a house committee ready to strike down Michelle Oabama’s school cafeteria bill that required more fruits and veggies,heavily lobbied by food corp, why wouldn’t we want to proactively get ready?

    We are not unhealthy, we are sick. Unhealthy is a few extra beers and some chips. Type II diabetes is unmanaged by a large uninsured population within our walls and while comprehensive medical care would be nice informing people how unhealthy sodas are is a good start. Lot of people don’t even know that you can drink an entire meal in a soda.

    If it doesn’t work to educate the public then why did smoking rates go down? Soda companies will be fine. We can go back to cans and ditch the huge cups.

    • Well, Allen.

      First of all, guess what those students were doing with that healthy food? THROWING IT OUT.
      That’s your tax dollars at waste.

      I agree with Council Member Krier (A Good Mayoral Candidate for 2015, he or Gallagher’s got my vote!!! and I ran before in this town!)

      A lot of people are also hypertensive. We aren’t forcing them to take anti-hypertensives are we?

      A person could have high blood pressure before they hit puberty.

      It’s based on genes.

      The city should do something about it’s lack of policing, and community services that keep young people on the straight and narrow. That starts NOT IN PRESCHOOL, but in MIDDLE SCHOOL!

      Scrap the Pre-K program and replace it for Life Skills education for Middle Schoolers. Increase funding for the D.A.R.E. program.

      Do field trips to correctional facilities to educate our youth about CHOICES.

      What does this got to do with obesity, you say?

      A young parent starting out on San Antonio’s East Side can’t take family walks with their siblings in fear of gun shots.

      Yes some places are like that. Cherry Street, Goliad Road I am looking at YOU.

      Encourage the family unit.

      Offer marriage counseling services to at risk.

      Discourage teen pregnancy, gangs, hard core drugs.

      This issue is non partisan, You have Bill O’Reilly pleading to President Obama to get the ball rolling on this things.

      I am not obese. I drink a lot of soda, and never touched a vegetable in my life, the exception being Spicy Hot V-8. I am a mild diabetic, simply because my father and my grand father are diabetic.

      My Grand Dad we didn’t find out he was a diabetic until he passed and he was in his 80’s.

      When the nursing home started feeding him lot’s of broccoli. He had a heart attack, and died from the diet changes at the home just after breakfast.

      Before he was in the nursing home, he would eat hamburgers using the George Foreman grill with baked potatoes with a dollup of butter, and fried fish from long john silvers. He was an alcoholic, which caused his dementia and Alzheimer’s (why we had to put him in a home)

      Alcohol and Aspartame can destroy your brain. So can Fluoride.

      I enjoy my life, because I don’t want to end up with Alzheimer’s.
      If I had to choose my poison, it would be a heart attack in my sleep.
      I will keep my memory, thank you very much.

      It is issues like this that get me into politics, and turned me Libertarian-Conservative Republican.

      The mainstream Democrats basically loses my support when they talk about dictating what I, as an adult, eat, drink, and smoke. Also what grocery bags to use, what meters to have on my private property, and what light bulbs to put in my home.

      While, I just mentioned a non partisan solution, having our elected officials support such solution is critical to voter approval from all sides of the aisle.

      • Will, wow man…

        1. Your diet already IS heavily dictated by an industry whose production and distribution system pushes highly-processed starches and factory-farmed meat. It just happens that you eat more-or-less in line with this dictate, so of course you feel free under the status quo, but threatened by those who’d promote better access to real food.
        2. Obesity isn’t simply “based on genetics” as you dishonestly (or just ignorantly?) assert. Barking that line repeatedly doesn’t make it so. Predictive patterns emerge in an entire population, not a few personal anecdotes. Try education, it’s fun.
        3. Claiming that broccoli triggered your granddad’s heart attack makes it damn-near impossible to take you seriously.
        4. The power of government to enact laws concerning grocery bags and light bulbs is essentially the same as that for laws prohibiting you from dumping your used motor oil into the river. As my right to swing my fist ends where your nose begins, “personal choices” can be regulated at that point where they affect the greater good. When such laws aren’t supported by actual data, I’d suggest learning and arguing from said data, rather than on the basis of “muh freedums!”
        5. The meters on your property belong to the company selling you gas and electricity, and that’s part of the contractual requirement of living on that grid. If you don’t want to do business with them, you’re of course free to move off that grid and generate your energy independently.
        6. I don’t care for gangs or hardcore drugs either, but you really strayed off-topic there. I don’t see a lot of obese gangsters or meth heads, nor is it easy to believe they’re secretly behind the processed food and sugar drink industry.

  4. Whether Joe Krier likes it or not, government will be involved either by helping prevent obesity, like they are attempting here, or at the tail end when paying for obesity’s disastrous costs to society. Preventing it in the first place and improving quality of life seems more practical.

  5. San Antonio needs more than suits and smiles to reduce obesity. San Antonio needs drastic shifts in awareness, consciousness and vibration to ascend.

    Here are some keywords to consider while addressing San Antonio’s obesity epidemic:

    advertising, marketing, mainstream media
    city walkability, automobile dependency
    health care industry, disaster capitalism
    culture, tradition, education, ignorance
    artificial, nonnatural, impurity
    deception, exploitation
    excess, gluttony
    self-control
    well-being

  6. I went to an event at the ATT center. In front of me was a family: Father, mother and 3 kids.

    The oldest of the kids could not have been more than 12 years old.

    The entire family looked like a set of fat Matryoshka dolls laid out in a row. All of them had the pack of hot dog fat rolls on the back of their necks. Pretty sure there was not a single one of them under 200 pounds. The parents were both morbidly obese.

    They were constantly getting up and coming back with some other set of items from the concessions. I wouldn’t be surprised if they each had 1 thing off the menu. Nachos, hot dogs, pizza.

    At the end of the 3 hour event, there was a mountain of garbage on the floor in front of them. A truly disgusting and shameful thing to witness. Pretty sure the city spending more money on anti-soda propaganda is not going to change that.

  7. It is illegal pursuant to Texas law to even have this discussion. I can see Coca Cola and PepsiCo suing the City of San Antonio under the State’s Product Disparagement laws. If I remember correctly, Oprah got sued over beef in the late 90’s. She won the lawsuit only because of her celebrity status and the Plaintiffs in the case decided not to appeal the case any further.

    Word of caution, Don’t slander corporations.

    Why is the city pushing the further drinking of the cities tap water? I will spell it out for you in all caps. FLUORIDE.

    Now, let’s remove the fluoride in the water, and people will start drinking tap water again!

    Why wasn’t the Fluoride issue in the tap water brought up? Fluoride is relevant to tap water as the city is medicating people WITHOUT their consent.

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