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.
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.
"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.
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 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."
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 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 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 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."
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."
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 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."
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.
"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."