2016-11-03 13:49:16
Putting Sugary Soda Out of Reach

Can public health officials force Americans to break their soda habit?

The answer may come soon from the University of California, San Francisco, a health sciences center that has more than 24,000 employees on its sprawling campus. Last year, U.C.S.F. removed sugar-sweetened beverages from every store, food truck and vending machine on its campus. Even popular fast-food chains on the campus, like Subway and Panda Express, have stopped selling Sprite, Coca-Cola and their sugary brethren at the university’s request.

U.C.S.F. is believed to be one of the largest employers to remove sugary drinks from the workplace. With sugary sodas now a rare sight on campus, the university found that it had the perfect conditions to study what happens when people who were drinking large amounts of sugar during their workday suddenly stop.

U.C.S.F. researchers have enrolled 214 of the school’s employees into a rigorous study, collecting blood samples to see if there have been any major metabolic changes in the people who lowered their soda intake. While they expect to publish complete results soon, early indicators are promising.

Since the policy went into effect a year ago, the university says it has recorded a significant drop in soft drink consumption among its employees, particularly lower-income service workers, who were the biggest consumers. A university survey of 2,500 employees found that some service workers and support staff members had been drinking up to a liter of soda at work and at home each day, or almost three cans. Six months after the policy went into effect, these workers had reduced their consumption by about a quarter.

“We’re a public health institution, and there’s something not right about us making money off of products that we know are making people sick,” said Laura Schmidt, a professor at the U.C.S.F. medical school who spearheaded the beverage initiative. “How dare we profit off of a product that our own doctors say causes metabolic disease?”

The university’s experiment comes at a time of growing battles over policies aimed at curbing soda consumption. On Tuesday, three cities in Northern California and one in Colorado will be voting on whether to tax soft drinks. The cities of Berkeley and Philadelphia have already approved taxes on sugary beverages. One recent study found that the Berkeley tax was working: In low-income areas, sugary drink consumption fell and water consumption rose after the tax went into effect. Last month, the World Health Organization urged countries around the world to impose a tax on sugary drinks, presenting research that showed just a 20 percent increase in soda prices would result in a proportionate reduction in their consumption.

The beverage industry has been fighting back, spending millions on ad campaigns against the proposed taxes in California and Colorado, which it calls a regressive “grocery tax” that hurts the poor. In September, the industry filed a lawsuit against Philadelphia, calling its soda tax illegal.

As the fights over soda taxes play out, many hospitals and health organizations have taken matters into their own hands, banning sugary drinks from their own workplaces. Nationwide, at least 30 medical centers have restricted the sale of soda and full-calorie sports drinks, including the Cleveland Clinic in Ohio and the University of Michigan Health System.

U.C.S.F.’s policy may be the most far-reaching. It applies not only to its medical center, but the entire university, including the aforementioned 24,000 employees and its 8,500 visitors and patients each year. Visitors to the campus now will find only bottled water, diet drinks, unsweetened teas, and in some cases 100 percent fruit juice with no added sugar.

Michael Flanders, an assistant specialist in U.C.S.F.’s division of hematology and oncology, said he had been consuming “tons” of added sugar daily from San Pellegrino Limonatas and other sugary drinks. But when the policy went into effect and the drinks disappeared, sparkling water became his drink of choice.

“It took my taste buds a couple months to adjust, but I’ve come to genuinely enjoy black coffee and unflavored fizzy water,” he said. “Soda and sugary coffee drinks now seem overwhelmingly sweet.”

But while the university says it hopes its policy will become a model for other large employers to follow, the beverage industry argues that the strategy is flawed. It points out that obesity rates have been climbing even as America’s soda intake has declined in recent years. And it says that focusing blame on soda alone, rather than calories from all foods, is misguided.

“Obesity rates have gone up steadily for years at the same time soda consumption has gone down for years,” said William Dermody, a spokesman for the American Beverage Association.

But Ms. Schmidt said it doesn’t make sense for doctors to urge patients to cut back on sweetened beverages while a university medical center continues to sell those same drinks. “I’ve spent years in the addiction field, and the first thing we tell people is that if you want to quit something, get it out of your environment,” she said.

Getting the university to stop selling sugary drinks was surprisingly easy, Ms. Schmidt and her colleagues say. The school’s chancellor, after some initial reluctance, decided that the goal was important, and many faculty members supported the idea. The university’s beverage supplier then agreed to stock the campus stores and cafeterias with mostly water and zero-calorie drinks. One exception was made for 100 percent fruit juices, which have natural but not added sugars.

The policy was announced last July and phased in over a four-month period as the university handed out pamphlets and other educational materials to students and staff members.

“We educated everyone and explained to people how harmful sugar sweetened beverages can be to health,” said Leeane Jensen, the director of well-being at U.C.S.F. “People got it right away, and they were all in support of it.”

Robert W. Jones, who owns two Subway franchises on the U.C.S.F. campus, said that when the school asked him to stop selling soda, he worried that it would upset his customers. But he got his beverage supplier, Coca-Cola, to swap out full-sugar drinks for water and other zero- or low-calorie options. He trained his workers to explain the policy to customers when they complained they couldn’t find soda at the fountain machines.

“The few customers that ask seem to get it right away,” he said. “There have been very few issues with it.”

Mr. Jones said that his beverage sales declined by about 10 percent in the first two months after the soda was removed, but that he recovered most of the business through sales of diet drinks and bottled water.

Whether the policy will have any measurable impact on health remains to be seen. Elissa Epel, the associate director of the U.C.S.F. Nutrition and Obesity Research Center, said she and her colleagues want to find out if employees who manage to reduce their overall sugary drink intake saw any impact on things like weight loss, liver health, insulin resistance and telomeres, the stretches of DNA that are linked to longevity.

“People may say they drink less,” she said. “But my question was: Does this show up in their blood? I wanted to know if there would be meaningful improvements in people’s metabolic health.”

One employee who is enrolled in the study, Kristine Obiniana, an analyst at U.C.S.F.’s medical center, said she had been consuming as many as three sugary drinks per day. “Soda, juices, coffee with sweeteners, all of that stuff,” she said. “I could see what my problem was.”

Ms. Obiniana said that when the policy first went into effect last year, she found herself bringing ginger ale, Dr Pepper and Capri Sun juices to work. But at 5 feet tall and over 180 pounds, she realized she needed to make a change. “I was just like, ‘How am I going to help myself if I keep doing this to myself,’” she said.

Eventually, she stopped bringing soda to work and started drinking water, tea and zero-calorie flavored drinks instead. She has lost five pounds and hopes to lose at least 20 more. She said she sometimes struggles to avoid sugary drinks when she is at home or going out with her friends, but feels good that the university no longer sells them at her place of work.

“It makes me feel like they really care about their employees and what people are putting into their bodies,” she said.