Will 'No Big Soda For You' Regulation Curb Obesity in New York?

No Big Soda For You! (Big Gulps OK, Though!)

It was no surprise to ACSH staffers and many New Yorkers yesterday when news broke that the New York City Board of Health had approved a mayoral regulation banning super-sized sugary drinks at certain restaurants, concession stands, and other eateries.

The legislation, strongly promoted by Mayor Bloomberg and his Department of Health, goes into effect March 12 of 2013. It puts a 16-ounce limit on the sale of non-diet soda, sweetened teas, and other beverages. But not to worry - you can still get your venti pumpkin-spice latte with extra whipped cream, because the ban will not affect drinks consisting of more than 50 percent milk or milk substitute, nor will it affect 100 percent juice beverages.

The regulation is based on the supposition that restricting super-sized sugary drinks will significantly lower calorie consumption, and thus the prevalence of obesity, among New Yorkers. We at ACSH find this logic flawed.

"We of course agree that obesity is a significant health threat," says ACSH's Dr. Gilbert Ross. "Yet recent data indicate that, in New York City at least, the proportion of young school children who are obese has actually declined somewhat in the last few years - and this did not occur with any governmental restrictions on beverage size."

As ACSH's Dr. Ruth Kava observes, "The only thing that might come from this piece of legislation is increased awareness." As she points out, "Consumption of excess calories from any source, not just calorically-sweetened beverages, will lead to weight gain and should be discouraged. A focus on a single source of calories or a single food is inappropriate, and likely to be ineffective."

ACSH's Cheryl Martin also notes how media coverage of the new restriction has focused on opposition almost solely from corporations and trade associations. "What about the consumers?" she asks. "Recent polls show that a majority of New Yorkers are also not so keen on the ban."

"This intrusive measure will have zero impact on the totality of obesity in New York," says ACSH's Dr. Elizabeth Whelan. "As one of the members of his own board of health told the mayor, the problem should be treated 'holistically,' not by focusing on one ingredient or product. Ultimately, the proposed restriction constitutes an unwarranted experiment on New Yorkers, without their consent, and should not be imposed upon them." Work stress linked to heart disease It turns out that the stress of a demanding job, combined with having little control over it, could be a deadly combination, according to a recent UK study. In a meta-analysis of published and unpublished studies, researchers from University College London analyzed the association of job stress - defined as high work demands and low decision control - with the risk of heart disease. The review, published in The Lancet, assessed nearly 200,000 employees from seven European countries between 1985 and 2006.

At baseline, all of the study participants completed questionnaires assessing job strain, with questions ranging from workload to decision-making freedom. After controlling for certain confounding factors such as lifestyle, age, gender, and socioeconomic status, researchers found that people with highly demanding jobs and little freedom to make decisions were 23 percent more likely to experience a heart attack compared to their less stressed counterparts.

The study's lead researcher, Dr. Mika Kivimaki, believes the findings are the first in its field to be derived from an analysis conducted with such precision and accuracy. But ACSH staffers are not as convinced and believe the research suffers from significant limitations.

"Evaluating a parameter as vague as job strain by questionnaire will be fraught with inaccuracy," Dr. Ross says. "Moreover, the study was a meta-analysis of published and unpublished studies, which means that at least some of the data had not undergone peer-review."

And while Dr. Kivimaki suggested that reducing workplace stress might decrease disease incidence, she also acknowledged that "this strategy would have a much smaller effect than tackling standard risk factors such as smoking and physical inactivity."

Dr. Ross agrees: "Dealing with known heart disease risk factors such as smoking, hypertension, and lipid levels will be far more beneficial to heart health than controlling workplace stress," he says. "Individuals should aim to first address known risk factors if they're serious about preventing adverse cardiovascular events." Pregnancy safe for most heart disease patients Compared to their heart-healthy counterparts, pregnant women with heart disease have a higher risk of complications. However, a recent analysis published in the European Heart Journal shows that the large majority of these women will have positive outcomes, both for themselves and their newborns.

For the study, a team of researchers from Erasmus Medical Center in Rotterdam analyzed data on over 1,300 pregnant women, sourced from 28 countries between 2007 and 2011. All of the patients suffered from either valvular heart disease, congenital heart disease, ischemic heart disease, or cardiomyopathies.

Most of the women had early stage heart disease, yet the study results still showed that, compared to pregnant women without heart disease, this group had higher rates of preterm birth, fetal death, and maternal mortality. However, the rates of such occurrences themselves actually remained low. That is, researchers found that pregnant women with heart disease had a 1 percent mortality rate, compared to 0.007 percent among healthy women. The risk was particularly intensified in women with cardiomyopathy and those living in developing countries.

Overall, however, the results suggested that, with "adequate counseling and optimal care" (both pre-conception and during pregnancy), women with heart disease should not be deterred from becoming pregnant.

"On the whole this is good news," says Dr. Ross. "But women suffering from heart disease should be aware that they are at risk of more complications. Pregnancy is in itself a risk, and unfortunately there's no way around that. But if a women with heart disease chooses to get pregnant, it is very important for her to have the best possible care and have any remediable conditions dealt with ahead of time - including valve replacement, if indicated."

ACSH's Dr. Josh Bloom seconds that. "According to this study, maternal mortality occurred at a rate of 1 percent among this cohort of 1,300 women. That's 13 women - not an insignificant number," he says. "In fact, it means that there is a 130-fold increased risk of death." NSAIDS may have significant cardiac liability Coming on the heels of a study published in May of 2011, more evidence suggests that non-steroidal anti-inflammatory drugs (NSAIDS) increase the risk of a second heart attack.

The new study, published in the journal Circulation, analyzed data on nearly 100,000 patients who had suffered a heart attack between 1997 and 2009. The results showed that, compared to non-users, those who took NSAIDS had a 59 percent higher risk of dying from any cause within a year. That risk increased to 63 percent within five years. The findings were similar for both men and women, and the researchers took into account other confounding factors, such as age and income.

Some of the more commonly used NSAIDs include Motrin and Advil (ibuprofen), Aleve, and the prescription drug Celebrex. It's important to note, however, that aspirin is not included in this group of NSAIDs, since its effects are, on balance, protective against heart disease. Tylenol (acetaminophen) was also not part of the study, as it is not an NSAID.

"While study after study has demonstrated higher cardiac risks for NSAID users, perhaps based on elevated blood pressure and platelet effects, the risk is hardly an emergency," says Dr. Ross. "Patients with heart disease or at higher risk of it should discuss alternative treatments with their care-givers." Advisor comment: Do drink the (fluoridated) water In yesterday's Dispatch we applauded Portland, Oregon for finally approving a plan to add fluoride to its community water supply.

The story prompted ACSH scientific advisor Dr. Bob Brent to write in with the following observation:

The fact that Oregon has decided to fluoridate its water supply is an interesting news item because it focuses on a new problem with regard to bottled water that does not have fluoride added. With the youth of our country drinking bottled water instead of fluoridated city water, the rate of dental caries may begin to rise in the USA.

Dr. Brent's point is a good one and, in fact, we recently discussed a study finding that, as the use of bottled water has increased, so has the incidence of cavities in baby teeth - which now affect about 42 percent of U.S. kids between the ages of 2 and 11.

As we pointed out then, the American Dental Association (ADA) recommends that parents make sure their kids are brushing their teeth twice a day with fluoride toothpaste (beginning at age two), seeing the dentist twice a year for a check-up and fluoride treatment (starting at age one) - and getting fluoride in their drinking water. Bottled water is of course fine now and then but, as the ADA points out, it shouldn't be a child's main source of drinking water.

You can also read our Dispatches on ACSH's blog: http://HealthFactsAndFears.com.