Strategies to Reduce Sugar- Sweetened Beverage Consumption: Lessons from New York City Anne Sperling, MPH Ashley Lederer, MS, RD Bureau of Chronic Disease Prevention NYC Department of Health and Mental Hygiene
Why Focus on Sugary Drinks? Sugary Drinks Extra Calories Weight gain Obesity Disease SSBs are the single largest contributor to the obesity epidemic We consume 200-300 more calories per day than 30 years ago with the largest single increase due to sugary drinks Nearly half of the added sugar Americans consume comes from sugar-sweetened drinks The typical American consumes 46 gallons of sugarsweetened drinks each year = 40 pounds of sugar per person Sources: Finkelstein EA, Ruhm CJ, Kosa KM. Economic causes and consequences of obesity. Ann Rev Pub Health. 2005; 26:239-257. Guthrie JF, Morton JF. Food sources of added sweeteners in the diets of Americans. J Am Diet Assoc. 2000;100:43-51. Bleich, SN, Wang YC, Wang Y, Gortmaker SL: Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr 2009; 89: 372:381.
Why Focus on Sugary Drinks? They are filled with empty calories SSBs result in poor calorie compensation They don t result in satiety There is proof of harm Among women drinking one or more soft drinks per day increases the risk of diabetes by 83% High consumption of SSBs has also been linked to increased risk of heart disease, osteoporosis and dental caries Sources: Schulze MB, Manson JE, Ludwig DS, et al. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle- Aged Women. JAMA. 2004;292(8):927-34. Malik VS, Popkin BM, Bray GA, Despres J-P, Hu FB. Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. Circulation. March 23, 2010 2010;121(11):1356-1364. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. Aug 2006;84(2):274-288. Gortmaker S, Long M, Wang YC. The Negative Impact of Sugar- Sweetened Beverages on Children s Health. RWJF. 2009.
Sugar-Sweetened Beverages in NYC: How Many Are We Drinking? In New York City, 32% of residents report drinking at least 1 sugarsweetened beverage a day Source: 2009 CHS.
Who Drinks the Most SSBs? Consumption is highest among NYC residents who are at most risk for diabetes and obesity Rates differ by neighborhood and income In NYC s lower-income neighborhoods residents drink twice as many sugary drinks as compared with residents of high income neighborhoods and by race/ethnicity 45% of Black residents drink 1+ sugary drinks a day 38% of Hispanic residents drink 1+ sugary drinks a day 22% of White residents drink 1+ sugary drinks a day Sources: 2009 CHS.
Percent of population Who Drinks the Most SSBs? Average daily sugar-sweetened beverage consumption and overweight/obesity among New York City adults 70 60 50 40 Household income by federal poverty level <100% 100% - 200% 200% - 400% 400% - 600% >600% 30 20 10 0 1 or more of any sugar-sweetened beverage Overweight and obese Source: 2009 CHS.
NYC Youth and Sugary Drinks For each additional SSB consumed daily, a child s risk of obesity increases by 60% In New York City.. 44% of children (age 6-12) consume one or more SSBs per day Over one third of public high school students consume at least one SSB per day Regular SSB consumption is more common among high school students who watch TV for three or more hours per weekday than among those who watch less (41% vs. 29%) Sources: Ludwig D, Peterson K, Gortmaker S. Relation between consumption of sugar-sweetened drinks and childhood obesity; a prospective, observational analysis. Lancet. 2001; 357: 505-508. Youth Risk Behavior Survey, 2009. Child Health Survey, 2009
Reducing SSB Consumption is a Citywide Priority Policy Outreach Media Research and Evaluation
SSB POLICY
Policy: NYC Food Standards Standards for Meals/Snacks Purchased and Served Apply to all food purchased and served by city agencies: >260 million meals and snacks served each year at schools, senior centers, day-care centers, and homeless shelters Standards for Beverage Vending Machines Apply to all agency-contracted machines Future plans: Considering guidelines for Cafeterias and Concessions Apply to all retail food locations on City property 10
Policy Timeline 2007 2008 2009 2010 2011 Mayor created Food Policy Coordinator position Food Procurement Workgroup convened and Standards developed EO 122 signed. Requires agency compliance with NYC Food Standards Standards for Meals/Snacks Purchased and Served in effect March 2009 Standards for Beverage Vending Machines in effect May 2009 Ongoing: Implementation support
NYC Standards for Meals/Snacks Purchased and Served Beverages: Beverages must be 25 calories per 8 ounces (except juice and milk) Juice: 100% fruit juice Milk: 1% or non-fat, unsweetened
NYC Standards for Beverage Vending Machines 1. Product mix 2 vending machine slots must stock water High-calorie beverages ( 25 calories/8-oz serving) limited to 2 slots 2. Product placement Water: Area with greatest selling potential at eye level High-calorie beverages: Area with least selling potential 13
New York City Standards for Beverage Vending Machines 3. Product size All beverages except water are limited to 12 oz Water must be at least 12 oz 4. Promotional space Marketing on the outside of the machine must promote healthy lifestyles or healthy beverages 5. Calorie labeling All machines must post calories per container for each product Recommended pricing models Water priced at $1; high-calorie beverage priced at $1.50 14
Creating a Healthier Beverage Vending Environment Water more available in machines High Calorie beverages not at eye level Limits advertisement of sugar-sweetened beverages Fewer high calorie beverages sold, in smaller sizes Calorie amounts available per product
Policy Implementation Technical support includes: Trainings Site visits Menu review Nutrition technical advice
Policy Implementation Boilerplate language and Standards are included in all new contracts for food and food services. Development process: Worked closely with Mayor s Office of Contracts Food Policy Coordinator and Health Department presented at meetings for Agency Chief Contract Officers Language and standards are included in programmatic, caterer, and vendor contracts
SSB OUTREACH
SSB Outreach: A 5-Tiered Approach 1) Outreach to community and faith-based organizations 2) Outreach to private businesses and worksites 3) Grant funded education and systems-change projects 4) SSB-related messaging incorporated into other DOHMH programs 5) Education to community leaders and key influencers
SSB Outreach: Community Action Kit Used for outreach to CBOs and FBOs Contents: Letter from the Commissioner SSB FAQs 10 Reasons to Avoid SSBs SSB Policy Checklist Bookmarks & Fans DVD including: Drinking Yourself Fat Video PowerPoint Training Tool
SSB Outreach: Community Action Kit
SSB Outreach: Our Approach Deliver PowerPoint presentation and distribute toolkits Make follow-up call to identify which policies will be adopted Conduct follow-up visit(s) to track implementation, and provide support Enter all activity into database for monitoring and evaluation purposes
SSB Outreach: Workplace Action Kit
SSB Outreach: Workplace Action Kit
SSB Outreach: CBOs, FBOs and Worksites To date: 400 organizations received presentations 11,742 individuals received SSB education 146 organizations adopted policies
SSB Outreach: Getting out the Message Incorporating SSB education into other areas: Working SSB-related deliverables into grants Including SSB messaging in other DOHMH programs: Maternal/Infant Health School Nurses Nutrition and Physical Activity Programs
SSB Outreach: Getting Out the Message
SSB Outreach: Community Leaders Schedule meetings with key influencers to provide information on the health impact of SSBs Provide relevant community data on SSBs, obesity and diabetes Provide education around other DOHMH activities aimed at reducing chronic disease
SSB MEDIA
SSB Media: Campaigns Pouring on the Pounds, Big Sugar and Little Sugar Campaigns Subway Posters Viral Videos Television Earned Media Op-Eds and Press Releases
SSB Media: Pouring on the Pounds Ran in subways September- December 2009
SSB Media: Pouring on the Pounds Drinking Fat video went viral in December 2009 ~820,000 hits on YouTube http://www.youtube.com/drinkingfat
SSB Media: Little Sugar Ran in subways August- October 2010
SSB Media: Little Sugar Man Eating Sugar video went viral in October 2010 ~150,000 hits on YouTube http://www.youtube.com/watch?v=62jmfv0tf3q
SSB Media: Big Sugar Ran in subways January- March 2011
SSB Media: Big Sugar
SSB Media: Big Sugar Big Sugar TV Spot January March 2011 http://www.youtube.com/drinkingsugar
SSB Media: Facebook www.facebook.com/eatinghealthynyc
SSB RESEARCH
SSB Research and Evaluation Aimed at monitoring the impact of our work and better understanding attitudes, accessibility and availability of SSBs: Street Intercept Survey Public Opinion Poll Retail Audit Community Leader Focus Groups Media Campaign Evaluation Survey
Available Resources Please contact us for additional information on how to access and utilize the following resources: Community Action and Workplace Strategies Kits Sugar Health Bulletins Media: Posters and Videos Research Tools: Surveys and Polls Focus Group Moderator Guides Many of these resources can also be accessed on our website: www.nyc.gov/html/doh/html/home or contact asperlin@health.nyc.gov
THANK YOU For additional information, contact: Anne Sperling: asperlin@health.nyc.gov Ashley Lederer: alederer@health.nyc.gov