Monthly Archives: July 2015

Junk Food Taxes: Do They Work?

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The Navajo nation recently became the first place in the United States to impose a tax on junk food in an effort to address concerns about obesity in their communities. A “sin tax” to disincentivize the consumption of foods associated with health risks is not new, but it is gaining momentum as communities recognize the need to create food environments that are health promoting. So far, soda and sugar-sweetened beverages have been the primary targets.

Soda and sugar-sweetened beverages have been implicated as a major source of excess calories, leading to weight gain.  Nationally, Americans consume an average of 1 gallon of soda each week, or about 1000 calories completely void of nutrients.  Sugar-sweetened beverages account for roughly half of the 250-300 additional calories American are consuming compared to 60 years ago.  In response, taxes have been proposed in many states to discourage the purchase and consumption of sugar-sweetened beverages.  Thirty-four states currently have a sales tax imposed on soda sold in grocery stores, and 39 states tax vending machine sales.

The most prevalent argument in support of a sugar-sweetened beverage tax (SSB) is the effect on public health.  Health care costs for Americans with obesity are 36% higher than for Americans with a normal weight and prescription drug costs are 77 % higher.  Current estimates suggest a loss of $30 billion in productivity on the job each year due to lifestyle related health issues. Taxes are currently imposed on cigarettes and alcohol in an attempt limit their consumption and encourage healthy behavior.  Many public health advocates believe that a SSB tax would be reasonable and effective as well because consumers generally respond to higher prices by decreasing consumption.  The funds from taxes would ideally be used in nutrition and health education programs, and this is exactly what the Navajo nation plans to do.

The theory that increased price of SSB would reduce obesity rates is not currently well supported by the research.  Most taxes on soda are a sales tax that consumers do not see when they are making the purchase decision.  Current sales tax rates of 3-4% in participating states has not significantly affect the weight status of adolescents.  In addition, one study found only a 0.16% reduction in BMI in states with a sales tax on soda. Due to consumers’ propensity to substitute consumption choices, other studies show that any reduced soda consumption increases consumption of not only water, but milk, alcohol and juice.  Therefore, it is not clear that a tax on SSB would reduce BMI for overweight and obese individuals.

Current academic research fails however to present a holistic picture of the SSB tax, focusing specifically on weight loss.  While substitution of milk and juice for soda may not reduce weight, it will contribute necessary micronutrients that are typically inadequate to the diet of Americans like potassium, magnesium and calcium. We also know that BMI is not a strong indicator of health, as people with BMI scores in the overweight and obese categories can achieve positive health outcomes through health-promoting lifestyles, while people in the normal BMI category are at risk of poor health outcomes if they pursue health-detracting lifestyles (HAES cite). Viewing the tax through a health-based evaluation paradigm, rather than a weight-based paradigm may show more desirable outcomes.

As suggested in the research studies, current sales tax rates are too low and not visible enough to significantly impact consumer choices.  A higher rate in the form of an excise tax is another way to influence SSB consumption.  One study suggests it would take a 10% increase in price to produce an 8% reduction in soda purchases.  An excise tax (included in shelf price vs. at the register) of this magnitude, might be a more effective strategy for directing consumers away from soda.  This is more than double the tax rate imposed in participating states, and 5 times that of the Navajo nation. Furthermore, the increased price would be visible at the point of selection (when purchasing decisions are made) rather than at the point of payment.

While taxes are not the comprehensive solution to changing health-detracting behaviors, they can help shape the food environment to be more health promoting. If the Navajo nation looks beyond weight-based measures of success to health-based measures, their policy for shaping the food environment may ultimately become a model for other places in the United States to emulate.

 

1. http://time.com/3762922/junk-food-tax-obesity-navajo-nation/

2. Pratt, Katherine. A Constructive Critique of Public Health Arguments for Antiobesity Soda Taxes and Food Taxes. Tulane Law Review [online]. 2012; 87 (1): 73-140. Available from: LexisNexis Academic.

3. Kiviat, Barbara. Tax and Sip. Time [online]. 2010;176 (2): 51-52. Available from: EBSCOhost.

4. Powell, LM. Associations between state-level soda taxes and adolescent BMI. Journal of Adolescent Health.

5. Bacon, L. (2010). Health at every size: The surprising truth about your weight. BenBella Books.

6. Wansink, B., Hanks, A. S., Cawley, J., & Just, D. R. (2014). From coke to coors: a field study of a fat tax and its unintended consequences. Wansink, Brian, et al.” From Coke to Coors: a field study of a sugar-sweetened beverage tax and its unintended consequences.

7. Andreyeva, T., Long, M. W., & Brownell, K. D. (2010). The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. American journal of public health, 100(2), 216.

2009; 45 (3) Suppl pg:S57 -63

What to do When you Hate Beets?

Fresh Beets
I don’t like beets.  When we hear this from children, we encourage them to try again, hoping they might like them once they get older.  Curiously though, once we become adults, encouragement to try disliked foods ceases and we develop the belief that our food preferences are fixed.  We might even justify this belief by claiming a genetic predisposition to dislike certain flavors or foods.  I don’t like beets, and at this point, I never will.  However, even a genetic predisposition to a certain trait does not necessarily equate to predetermination of behavior.  Our mental beliefs play a substantial role in our preferences for food.  And the good news is, our mental beliefs change.
As living beings, we are constantly changing.  At the conscious level, new experiences shape our ideas.  And at the unconscious level, all of our cells are reproducing and dying, our atomic energy arises, then passes away instantaneously.   We are literally changing both at an emotional level and physical level in every moment.  Consequently, we are not the same person we were yesterday, or last year, so how can we expect that our food preferences also do not change?
I certainly did not grow up eating fruits and vegetables.  Nor did I have parents who ate them. Typical childhood meals consisted of frozen pizza, Ramen noodles, and macaroni & cheese until I was 24 years old.  I doubt I even heard the word nutrition until my early 20’s, although I had certainly heard the word “diet” and been on several of them by that time.  All of that changed when I moved to Burma.  I was astonished by what real, fresh food looked like on the table in front of me when sharing meals with Burmese friends.  Needless to say, the dearth of fast food restaurants and Western packaged food meant that I had to learn how to eat vegetables.  Funny thing is, I now wonder why nobody ever told me how delicious they are!
It is well documented that it can take children 15-20 exposures to develop a taste for a new food. Trust, independence-seeking behaviors, and taste bud development all play a role.  However, more fundamentally, at each exposure we are an entirely new person, and this doesn’t stop when one reaches adulthood.  Therefore, even as adults, we can learn to like previously disliked foods if we keep these two facts in mind.  We can choose just one or two vegetables for our “let me learn to like this” bucket list, and make a strong determination to try them in various forms over the next few months or even years.
Practicing mindful eating can help enhance our expectation of liking a food (2). Prepare smaller quantities and taste the food slowly.  Notice the flavor and texture without labeling it as good or bad.  Be aware of how you feel about the flavor or texture, without judging the feeling.  Just notice.  If you still don’t like the food, accept the reality of that moment with kindness, and be determined to try again another day-knowing the person who tries this food again in the future will be new and different.
I now like beets.  It happened recently with a roasted beet and brie salad, and then again with a beet and coconut curry over rice.  With a strong determination to taste them, without consideration of past preferences, after 2 years of trying, at the age of 32, I finally like beets.
1. Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, Kelcy Press, 2008.
2. Hong, P. Y., Lishner, D. A., Han, K. H., & Huss, E. A. (2011). The positive impact of mindful eating on expectations of food liking. Mindfulness, 2(2), 103-113.

The Multiple Dimensions of Food

I recently had the opportunity to attend the National Wellness Conference 40th Anniversary Legacy & Vision Dinner, during which several pioneers of the Wellness movement discussed their involvement in shaping the dialogue and structures inherited by younger generations.  One particularly grounding message for me was a reminder by John Travis, MD, MPH, that above all, the currency of wellness is connection.  We understand that what we eat is important for maintaining our physical wellness, and foodies have long advocated that being connected to our food helps us make healthy food choices.  However, as many of us intuitively know, food is about more than just healthy or unhealthy choices.  Food is a medium through which we connect to multiple dimensions of wellness.
Social connection is crucial to our well-being.  Quality social connections can reduce mortality by 50% (1) and observations from Blue Zones indicate that social connection contributes to the long, healthy lives enjoyed by the centenarians living in these communities (2).  However, many Americans have developed the habit of eating alone- at our workstations, in restaurants, and in our cars.  Food is a natural facilitator of social bonding.  Everyone eats, and everyone can talk about food.  While food is not the only way to facilitate social bonds, sharing cake at a friend’s wedding, enjoying a tomato salad with colleagues, or tasting mango-chicken curry on a family night out builds shared experiences and enhances opportunity for meaningful social connection.

Our intellectual well-being, the degree of engagement in creative and stimulating activities to expand ones knowledge and share this knowledge with others, is an essential element in our lifelong journey toward wellness (3).  Intellectual wellness can positively impact resiliency in the face of mental health difficulties and the ability to cope with stressful situations (4).  The connection with food, by gardening, photography, cooking, and even genetic engineering, is a way through which to exercise our intellectual and creative nature.

Food and eating behaviors also serve as symbols through which individuals connect with their faith and spirituality.  Special foods are prepared to celebrate important religious events and donated as a way to show respect and selflessness.  Avoidance of certain foods and fasting are a means of obtaining spiritual purification and heightened awareness.  Even though more people are transitioning away from organized religion, food is often still a symbol of values and morality in their lives.  Avoiding harm to animals through a vegan diet or eating organic vegetables may enhance spiritual connections and a sense of oneness with the world.

Emotional wellness can be promoted through a balanced and positive approach to food.  Emotions and food influence each other bi-directionally in ways that can both support or diminish our emotional wellbeing.  Stress may cause us to reach for comfort foods, while the over consumption of unhealthy foods may be a risk factor for depression and low energy (6). Excessive worry about health is associated with a decline in quality of life as inner guilt and self-hate are not the seeds of self-care and wellness as (5).  A connection with food, absent of guilt and worry, can improve our emotional well-being.  We feel rewarded when we cook a delicious meal, or believe we improved our community by purchasing local foods.

More than 15 million people depend on food production, manufacturing or service in the United States (7).  Chefs, nutritionists, plant breeders, farmers and truck drivers connect with food through the pursuit of a meaningful livelihood.  However, many of the employment opportunities available in the food and agricultural industry still place workers in unhealthy and stressful situations that are not conducive to occupational or overall wellness. Unmanageable work-family interfaces increase the likelihood of choosing unwanted foods and eating behaviors as a coping mechanism (8). The rise in worksite wellness programs can help more individuals positively manage the work-family interface, enabling food choices they find acceptable, increasing job satisfaction and occupational wellness.

Given that food influences so many aspects of our well-being, let’s ensure, as wellness champions, that our advice and wellness programming consider the full spectrum of the human experience with food. Our promotion of healthy diets need not detract from overall wellness, but rather it should enhance balance and connection with food in all of its dimensions of wellness to support people in realizing their full potential for health and happiness.

References:

1. Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316.
2. Buettner, D. (2012).The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest. National Geographic Books.
3. Roscoe, L. J. (2009). Wellness: A review of theory and measurement for counselors.Journal of Counseling & Development, 87(2), 216-226. http://www.stuaff.niu.edu/stuaff/grad_resources/pdfs/Wellness%20Article_Counseling.pdf
4. Hammond*, C. (2004). Impacts of lifelong learning upon emotional resilience, psychological and mental health: fieldwork evidence. Oxford Review of Education, 30(4), 551-568.
5. Sanhueza, C., Ryan, L., & Foxcroft, D. R. (2013). Diet and the risk of unipolar depression in adults: systematic review of cohort studies. Journal of Human Nutrition and Dietetics, 26(1), 56-70.
6. Rief, W., Glaesmer, H., Baehr, V., Broadbent, E., Brähler, E., & Petrie, K. J. (2012). The relationship of modern health worries to depression, symptom reporting and quality of life in a general population survey. Journal of psychosomatic research, 72(4), 318-320.
7. http://ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/ag-and-food-sectors-and-the-economy.aspx
8. Allen, T. D., & Armstrong, J. (2006). Further examination of the link between work-family conflict and physical health the role of health-related behaviors.American Behavioral Scientist,49(9), 1204-1221.