Metropolitan Health Director Dr. Thomas Schlenker has once again asked City Council to support a campaign promoting moderate consumption of sugary beverages. And once again several Council members, including Mayor Ivy Taylor, rejected any initiative that would discourage excess consumption of soda.
It's an "anti-soda" message that, over the past year, has been watered down to "soda moderation" and bundled with other fitness and healthy eating initiatives to represent a more comprehensive, broad fight against what Dr. Schlenker calls "diabesity," the often-linked cases of obesity and diabetes. The three-pronged approach of supporting active lifestyles, healthy diets, and a reduction of sugary beverages was presented by Dr. Schlenker, Matthew Baldwin of Parks and Recreation, Jeff Skelton of the Mayor's Fitness Council, and Dr. Bryan Aslip of Bexar County's University Health System to City Council last week.
The Center for Disease Control and Prevention considers over-consumption of sugary drinks to be a key target in controlling obesity, adolescent obesity and related diseases, such as Type II diabetes. Despite the preponderance of science, a majority of local officeholders appear to be unfamiliar with the research and wary of any taxpayer-funded initiative to attack the problem.
"There's pretty much universal agreement here in San Antonio that what we want to do is not regulate, not tax, but to educate the public," Dr. Schlenker said. "The only thing that I feel strongly about is that we educate in a way that people can understand and take some action on."
Dr. Schlenker was not asking for funding, although he once had envisioned a $1 million public education campaign the first time he brought a substantive proposal to City Council in 2014. This time around he only sought a Council resolution supporting an awareness campaign to combat San Antonio's over-consumption of sugary beverages. The campaign was initiated by Metro Health last year, but is now led by a Bexar County coalition after a working group composed of several stakeholders – including a Texas Beverage Association/Coca-Cola Company representative – reached an impasse when it came to messaging.
(Read more: County Takes on Big Sugar After City Effort Stalls)
San Antonio was ranked as the second fattest city in the country, but efforts by Metro Health and other partners have shown definitive results, in recent years lowering the city's adult obesity rate from 35% to 28%, meaning 87,000 fewer adults were sufficiently overweight to be rated obese.
There is no disagreement on the other two general initiatives supported by progressive programing encouraging healthy eating: VegOutSA, an initiative launched in February by the City, H-E-B and Blue Cross Blue Shield of Texas, and an array of active lifestyle programs such as Fitness in the Park and FitPass that San Antonio's Parks and Recreation Department oversees.
Taking on the powerful soft drink or sugary drink industry, however, is not going to happen under the present City leadership. It became clear last week that any broad initiative that includes a public campaign to reduce sugary beverage consumption will not win Council support.
Bexar County recently took the initiative away from the City of San Antonio and announced its own public education program in concert with other community partners.
When looking at the list of those partners, the most glaring absence on its list of partners is the City of San Antonio, said Councilmember Rey Saldaña (D4). Council members Ron Nirenberg (D8) and Shirley Gonzales (D5) also expressed support for the measure as presented as part of the comprehensive plan presented.
"With all respect to the beverage industry, they’re not going to tell the ill effects of a product they’re trying to sell ... I come from a community where some people don’t find out how bad some of their habits are until they’ve taken son or daughter to a doctor after they developed pre-diabetes,” Saldaña said after the meeting.
It's okay for City government to educate its citizens, he said. "It matters symbolically that the city does not support this ... (other Council members' refusal of support) is a misstep as far as I'm concerned.”
Several Council members maintain their stances from last year – that an initiative to discourage over-consumption of sugary beverages is outside of the scope of what City government should do.
"I become a little bit hesitant when we kinda get on what I think is a slippery slope of telling people what they should or shouldn't be doing," said Mayor Taylor. "I see the sugary drink conversation better suited as part of a larger scale discussion about addressing obesity and about health and fitness and allow people to make individual decisions rather than just honing in on one particular behavior."
That view flies in the face of history. Most major health initiatives of the last century have been led by government, ranging from vaccination programs to prevent and eliminate communicable diseases, such as polio and whooping-cough, to decades of war between public health officials and the tobacco industry, which spent hundreds of millions of dollars trying unsuccessfully to deny science linking cancer and other diseases to smoking, and later paid tens of billions of dollars in settlements for the public health crises prompted by widespread tobacco use.
Mayor Taylor said there were any number of other things that could then be endorsed or "demonized" by the City – watching too much TV, for instance.
"I think we have a tremendous opportunity through programs like Fitness in the Park (and #VegOutSA) to provide realistic options as well as provide information on sugary drinks," she said. "It's all about balance."
Council members Joe Krier (D9), Mike Gallagher (D10), and Ray Lopez (D6) strongly agreed.
"I'm troubled by the nanny state – (the notion that) we're going to pick something up and tell you that thou shall not eat it," Krier said. "There is not a single cause that says 'you do this and you'll get diabetes,'" indeed there are many factors, not only overconsumption of sugar.
But such overconsumption is, without a doubt, a direct contributor to some of San Antonio's most persistent public health challenges.
The medical community agrees that overconsumption of sugar is not the only problem, but there is no doubt it's a major problem. More than half of excess sugar in the average American's diet comes from one source: sugary beverages. Research shows that people who consume sugary drinks regularly — one to two cans a day — have a 26% greater risk of developing Type II Diabetes than people who rarely have such drinks. For every additional soda children drink in a day, their risk of obesity increases by 60%.
"The simplest message is often the easiest to follow," Saldaña said. "If we take only a comprehensive approach it’s not going to necessarily be effective."
Meanwhile, Coca-Cola has been contributing to local infrastructure and programming that supports other arms of the fight against "diabesity." In 2013, the Coca-Cola Foundation devoted $1.5 million to support SA2020 Health and Fitness programs, including the City's Parks and Recreation Department.
Coca-Cola gave $500,000 to the Mobile Fit and Ride to Own fitness initiatives in 2013. Most recently, a $200,000 Coca-Cola grant provided park improvements and programming for Labor Street Park. Woodlawn Lake Park and Harlandale Park also received funding from Coca-Cola in 2013 and 2012 respectively.
City leaders and staff have lauded Coca-Cola for funding local park renovations and programs in neighborhoods that need it the most. There is a long list of parks in need of renovation and it's literally impossible for the City to get to all of them. Corporate sponsorship has allowed countless park projects to get off the ground.
In 2013, the American Beverage Foundation for a Healthy America invested $2 million in grants to support San Antonio’s efforts to encourage employee participation in its wellness programs. The City of San Antonio saw 57% of its employees completing biometric screenings, well surpassing the City’s previous 20% participation rates, according to the American Beverage Association (ABA).
“From our perspective, a lot of community groups are focused on San Antonio because of the prominence of diabetes and obesity,” said ABA spokesperson Katherine McLane. "There are a lot of health initiatives focused on this market. At a certain point, it becomes over-saturated and the messages lose their effectiveness ... you want to put your eggs in the basket of something that will work.”
The ABA is actively seeking to officially support the City's VegOutSA program. McLane confirmed, as several Council members did, that the ABA has not contributed to any Council member's campaign.
"I got a chance to meet with some folks from the beverage industry today," Lopez said. "I don't know if they had a chance to show (other Council members) this video."
McLane then showed a video produced by ABA, Coca-Cola, Pepsi, and Dr. Pepper about its latest Mixify campaign that carries a message of moderation and balance.
"Spend a day on the couch? Go for something less," the child narrator says while a salad and water bottle comes into view. "Just finished an afternoon of frisbee? Maybe you've earned a little more," he concludes while an image of a sandwich and a nondescript brown, fizzy drink appears.
But some public health advocates worry that Coca-Cola's funding comes with a very obvious cost: exempting the company and the industry from taking responsibility for its contribution to the public health crisis.
Some frustrated members of the San Antonio Food Policy Council see it as a conflict of interest for the City to accept money from a corporation with obvious ambitions to squash a campaign that encourages people to consume less of its product.
"As a peer organization, we're disappointed and apprehensive about the implications of funding for programming through the Mayor's Fitness Council from the American Beverage Association. While their stated goal of selling primarily water is admirable, the majority of their member organizations' billings come from the sale of unhealthy sugary beverages, so the likelihood of a counterproductive conflict of interest is dangerously high," stated a spokesperson for the nonprofit organization in an email.
"The Food Policy Council has been offered funding from Coca Cola, and we have turned that money down because it doesn't fit our mission. The Mayor's Fitness Council has accomplished so much for health in San Antonio, we must ensure that what's required to implement programs does not undermine the founding goals of the city government's health priorities."
After the meeting last week, Dr. Schlenker was disappointed that an official endorsement wasn't proposed by Council, but optimistic that the Bexar County Coalition would carry the message through.
"Practicing moderation is great, but nobody knows what that means," Schlenker said. "Moderation in terms of soda consumption is not drinking it every day. If we can get that concrete, the problem with the message would be solved, but I think people are afraid to go there."
*Featured/top image: Mayor Ivy Taylor speaks during the City Council B Session on April 1, 2015. Photo by Iris Dimmick.