Some Eating-Disordered Thoughts

anorexia

In the June issue of The Sun, Kathryn Phelan recounted the true history of a high school basketball player (herself) with ambitions to be the fastest on the court. In the pursuit of ultimate thinness, knobby knees and random bruising are small prices to pay. She becomes an expert at making half a sandwich last through a 25-minute lunch period, savoring every tiny bite.

Her parents send her to a psychiatrist, which is annoying, but in only six months she will be 18 and emancipated (and free to be emaciated.) As it turns out, her parents will also be free from each other, because they will soon file for divorce.

But meanwhile, they send their child to another specialist, this time in eating disorders. He tells her she is thinner than most fashion models, and this is not intended as a compliment. Finally, the doctor tells her that…

[…] nearly everyone with an eating disorder will relapse. They are diseases you can never lose, just learn to manage.

The coach won’t let Phelan play basketball, which was supposed to be the whole point of this extreme physical makeover. Her response is to run around the gym track at night. In fact, she runs everywhere, in multiple layers of clothing, because it’s impossible to get warm.

It is also impossible to escape the compulsions. Phelan describes another visit to the eating disorders specialist:

When he walks in, he tells you that the anorexic girl in the appointment before yours died on his exam table — she went into cardiac arrest and did not recover. He is visibly shaken. He says this could happen to you: the chambers of your heart could degenerate and surrender, just like that.

Then, there is the guilt, when the ghosts of starved ancestors complain about their descendent’s stubborn and foolhardy ways. Of course, these interior symptoms are not discussed. Her lab results are good, so she figures, what the heck?

But the next status self-report — at 114 pounds — is not inspiring:

You have lost your starting spot on the basketball team, your credibility, a number of friends, and more than fifty pounds. Cravings arise suddenly — they feel elemental, primitive. Biological imperatives do not like to be repressed…

Phelan finds herself lying to friends about her weight. At the prom, her date tells her she looks like a corpse. We will not spoil the surprise ending, but it’s a doozy. It demonstrates an important principle: that many mental disorders evolve from common roots. And another important principle: that mental health professionals are eminently equipped to treat compulsive overeating as well as compulsive under-eating.

Here is a recommendation of another piece of narrative non-fiction, this time from the strikingly original neurobiologist, Dr. Billi Gordon, writing about symbolic eating. The subtitle is “When compulsive overeating becomes a language” and it is, among other adjectives, lyrical.

This is a short excerpt:

Compulsive symbolic eating is global because the world is starving for the staples of humanness… We crave a kinder, more salubrious world that will not do unspeakable things to us, and snicker while we tremble, laugh as we bleed, and say, you’re too this, you’re too that, you can’t go here, you can’t be that, you’re too old, you’re too bold, you’re too white, you’re too black, you’re too thin, you’re too fat.

Your responses and feedback are welcome!

Source: “Lost,” TheSunMagazine.org, June 2017
Source: “Symbolic Eating,” PsychologyToday.com, 11/23/13
Images (left to right) by richmooremi and  teleoalreves on Visualhunt/CC BY

Will the Mental Health Pros Answer the Call?

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When Dr. Pretlow attended the World Congress of Psychiatry in October, it was with this message:

I do think we need to convince the psychology field that disordered overeating and obesity is primarily a psychological problem, and it seems to be an addictive process. Yet, even though it is not established that disordered overeating and obesity is an addictive process, this does not preclude using addiction-model methods to treat it, which appear to be highly effective. I have the goal (or at least the hope) that the psychology/psychiatry field will take on the treatment of disordered overeating and obesity.

For obesity and eating disorders, it seems self-evident that therapy is needed as a first step, because therapy acknowledges one of the huge paradoxes of human nature. Before a person can be free to change, first that person needs to be accepted for herself or himself.

However, weight loss programs of every kind and in every price range have one thing in common: They start out with the premise that something is wrong with the person, and the flaw needs to be fixed. While many people actually are open to change, nobody wants to be fixed. The implication is insulting, and gets a person’s dander up. Therapy, on the other hand, begins with, and is based on, acceptance.

Some outlooks

Dr. Nicole Avena, who participated in the symposium chaired by Dr. Pretlow, says:

Some obese people I have talked with sound just like the anorexic patients I know, and there is a lot of data to suggest that they have underlying similarities in brain changes that occur as a result of over- or under-eating.

Before the event, she wrote what he called a brilliant analysis of why professionals in the Eating Disorder field sturdily resist considering obesity an eating disorder:

I have talked at quite a few eating disorders conferences and people did not like to hear me talking about food addiction as it might relate to eating disorders, because people typically think that if you are “addicted” the only cure is to abstain from the substance of abuse. And the last thing people who treat patients with eating disorders claim they want to do is tell them it is okay to restrict.

To put it another way, it seems that what holds them back is the fear of stirring up anorexia. But overeating can also lead to life-threatening co-morbidities, which are much more widely-spread than anorexia.

Dr. Caroline Davis, who also took part in the symposium, wrote:

In my view, it’s too broad a sweep to say that EVERYONE with a BMI greater than 30 has an “eating disorder”. That would “pathologize” about a third of adults in the Western world. I do think, however, that “compulsive overeating” is a disorder and that such a condition comprises more than just binge eating. I also agree that severe cases of all the conventional eating disorders can be modeled as an addictive process.

As we have seen, psychiatrists who do therapy are thin on the ground these days. For practitioners of the specialty, it is very much a seller market, and they mainly supply diagnoses and prescriptions.

Can the shortage of available headshrinkers be coped with? Some experts believe so, with the help of two promising solutions. One is psychiatric telemedicine, which overcomes distance and is a blessing for patients who don’t get around very well.

The other is “collaborative care in which non-psychiatrists would receive specialized training in mental health and practice based on their expertise.” A lot of that is already going on.

Your responses and feedback are welcome!

Source: “US faces severe shortage of psychiatrists as demand grows — report,” RT.com, 09/09/15
Photo by Carla216 on Visualhunt/CC BY-ND

Mental Health Professionals and Obesity

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Having discussed the almost non-existent role of psychiatrists in treating obesity, we now look at another related profession, that of psychiatric or mental health nurse practitioner. PsychologyToday.com offers a compilation of obesity psychiatrists searchable by city or zip code, and on closer inspection, most of the profiles are of psychiatric nurses.

Here is the site’s description of their function:

Psychiatric nurse practitioners, or mental health nurse practitioners, perform many of the same functions as a psychiatrist. This includes diagnosing mental illness and prescribing medication. Psychiatric nurse practitioners also act as a therapist, helping patients with depression, anxiety and suicidal individuals, as well as other conditions that can be remedied with counseling.

Nurses monitor for side effects and responses to medical treatments and offer information on medications so that clients can make informed choices about their use.

Looking at the individual profiles, it becomes apparent that not all psych nurse practitioners do therapy or counseling. A typical caveat might read, “My patients should be engaged in therapy with a therapist and must be compliant with my treatment plan.”

Plenty of variety

The clinicians who do therapy are admirably eclectic and integrative. Among the many non-medication modalities listed on their pages are cognitive behavioral therapy, behavior modification techniques, Internal Family Systems Therapy, Play Therapy, psychological counseling, relaxation and mindfulness training, mindful neuropharmacology, coaching, gestalt, Jungian, motivational interviewing, hypnotherapy, parenting support, nutritional counseling, holistic treatments, dietary supplementation, narrative therapy, spirituality, exercise during therapy sessions, acceptance and commitment therapy, and EMDR (Eye Movement Desensitization and Reprocessing).

Many who are listed as available to treat obesity do not seem to actually specialize in obesity. This may not actually matter, because despite their numerous and florid manifestations, most mental/emotional disorders stem from some very basic places. Practitioners often operate from a premise that psychiatric care is more of an art than a science. Those who work with children tend to specify that family and caregivers be involved.

The field includes others

Possibly most familiar is the clinical psychologist, a person with a doctorate, who is trained to make diagnoses, and is qualified to provide therapy to individuals and groups. A school psychologist does the same things and has an advanced degree in School Psychology.

Many other categories of mental health professionals provide counseling and, in some cases, assessments. These are clinical social worker, licensed professional counselor, mental health counselor, certified alcohol and drug abuse counselor, nurse psychotherapist, marital and family therapist, pastoral counselor, and peer specialist.

The two that might be most closely concerned with eating disorders are the certified alcohol and drug abuse counselor and the peer specialist. A peer specialist possesses “lived experience with mental health or substance use conditions.” Many people who have problems of this kind are only able to relate and respond to, and feel comfortable with, a counselor who has personally been through their particular kind of hell.

Your responses and feedback are welcome!

Source: “Find an Obesity Psychiatrist,” PsychologyToday.com, undated
Source: “Types of Mental Health Professionals,” MentalHealthAmerica.net, undated
Photo by Hey Paul Studios on Visualhunt/CC BY

Where Does Psychiatry Stand?

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Childhood Obesity News is interested in the proposition that obesity is most effectively treated by those trained in the field of mental health. Most obesity results from overeating, which ought to be defined as an eating disorder, just the same as undereating.

Childhood obesity is universally acknowledged to be multi-factorial. In a very recent paper, Rajesh Sagar and Tanu Gupta enumerate some of the psychosocial issues that affect quality of life in obese children — such factors as depression, anxiety, disordered eating, stress, body shape concerns, and low self-esteem.

Alleviation of those conditions certainly comes under the purview of mental health professionals. The report says:

Co-morbid psychosocial and emotional problems of obesity generally act as causal or maintaining factors of obesity and thus significantly affect the treatment outcome. Therefore it becomes imperative for the clinicians/pediatricians to broaden their clinical assessment and include screening of important psycho-social factors within the clinical examination of childhood obesity.

We discussed the current scarcity of psychiatrists in the United States. Some observers claim that psychiatrists do not want to take on seriously ill patients, because if the situation is bad enough to warrant hospitalization few psychiatric beds are available. So, then what?

Other headaches are the same ones shared by less thoroughly-credentialed therapists. A ton of paperwork has to be dealt with, either by the practitioner or an employee. The wait for government money might be a month or longer.

An insurer is somehow permitted to decide to pay less than the agreed-upon rate, and apparently there is little recourse. Online commenter “Jean 99” had this to say:

Historically, reimbursement for mental health services has been lower than for other specialties, yet the practitioner still has the costs associated with a practice… Some states, like Illinois, are ridiculously behind in their medicaid payments to providers, but the provider’s bills won’t wait. This is one of the reasons that fewer physicians are choosing psychiatry, particularly when many have astronomical amounts of student debt incurred for their professional education.

As we mentioned, Texas has offered to pay student loans for child psychiatrists who will serve in the places with most need. Maybe more states could try that. Maybe it could become a federal program.

Another side to the story is spelled out by commenter Marquita Martin. The Health Insurance Portability and Accountability Act of 1996 is supposed to protect patient privacy, and doctors believe that insurers have no right to see the chart notes that document their most intimate conversations.

Consequently, they don’t take patients with insurance. In response to the same Washington Post article, “Awghost5,” a social worker in private practice, explained:

Some insurance panels limit the number of clinicians who can accept their insurance in various markets. At least one major provider in my area told me that the panel was “closed to new clinicians” in my county, even though many of my friends who had that insurance, couldn’t find someone in network to save their lives.

In other words, there is some kind of protectionist con game going on. Restraint of trade, creating a monopoly — surely there is a law against using the suffering of real people as leverage in financial and political gamesmanship?

As of June 2017, the psychiatrist shortage had worsened, to where they are the second most recruited specialists (the first being family physicians). Forbes opinion writer Bruce Japsen noted:

In some areas of the country, the lack of psychiatrists in outpatient centers and in private practice is triggering a spike in healthcare costs as people with behavioral issues seek care in hospital emergency rooms…

Your responses and feedback are welcome!

Source: “Psychological Aspects of Obesity in Children and Adolescents,” Springer.com, 11/18/17
Source: “The troubling reason it’s so hard to find a psychiatrist in the United States,” WashingtonPost.com, 09/02/16
Source: “U.S. Psychiatrist Shortage Intensifies,” Forbes.com, 06/06/17
Photo by Franchise Opportunities Photos on Visualhunt/CC BY-SA

Shrinks Are Shrinking

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Childhood Obesity News is exploring the idea that people trained in the mental health field are the most appropriate and potentially effective treaters of obesity. Sadly, the psychiatric profession seems to be in something of a quagmire. For starters, it appears that the classic shrink is a dying breed.

The website Mental Health America lists the various types of mental health professionals we have in the United States. The psychiatrist must first be an MD before anything else, and is the only mental health professional who can prescribe medication. In the old days, a patient would spend months or years in Freudian analysis, but the direct counseling of patients does not much happen any more.

Then there is the child/adolescent psychiatrist, also an MD, trained to diagnose and treat emotional and behavioral problems. Again, many do not actually treat patients. The field also includes the psychiatric or mental health nurse practitioner, a registered nurse who has received specialized training.

A dire shortage

The National Council for Behavioral Health helps 2,300 not-for-profit clinics in need of staff to find psychiatrists. Recently, according to their spokesperson, that has been more and more difficult. As of two years ago, according to the federal government, there were about 4,000 parts of the country where psychiatrists were spread so thin the ratio worked out to about one psychiatrist per 30,000 people.

The state of Texas is not generally known for progressive attitudes or willingness to extend much of a hand to those in need, aside from advice to “pull yourself up by your bootstraps.” And yet, the Associated Press reported, Texas agreed to pay off the student loans of child psychiatrists, especially if they work in low-income areas and treat Medicaid patients. This is an indication of how bad things are.

Although psychiatrists are the only ones allowed to write prescriptions these days that is pretty much all they do. Prescribe, follow up, tweak the dosage, switch the patient to a different pharmaceutical formula — it’s all about the meds. Obviously, this is a crucial need.

Consider the point raised by an online commenter known as “shirley816,” a former patient who now works with many mentally ill people in a residential setting:

No one who is in need of a psychiatrist should be without a therapeutic support. All psychiatrists do in the treatment regimen is prescribe and monitor medications and if your mental disturbance is severe enough to warrant medications then you darn well should have a therapist to help with the day to day living with it.

Journalist Keith Humphreys reminds us that, legislatively, some progress has been made:

Congress increased Medicare’s reimbursement rates for outpatient mental health services and passed legislation strengthening benefits in insurance plans provided by large employers… The Affordable Care Act of 2010 built on these reforms by defining mental health as an “essential health benefit” in the Medicaid expansion and in private plans sold on health exchanges.

But, out of the few remaining psychiatrists only about half of them accept insurance, either private or public. Their scarcity allows them to conduct cash-only practices if that is their preference.

And who can blame them? Next time, we will look at the headaches involved in treating patients.

Your responses and feedback are welcome!

Source: “Types of Mental Health Professionals,” MentalHealthAmerica.net, undated
Source: “US faces severe shortage of psychiatrists as demand grows — report,” RT.com, 09/09/15
Source: “The troubling reason it’s so hard to find a psychiatrist in the United States,” WashingtonPost.com, 09/02/16
Photo by Kevin Dooley on Visualhunt/CC BY

The Chicago Soda Tax Rebellion

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Two previous posts traced the short life of the soda tax in Cook County, Illinois, which is mostly the city of Chicago. Last year, the Board of Commissioners voted in the soda tax, and it was in effect for mere weeks before ending as of December 1. Polls showed that 85 percent of the county’s people were against it, perhaps stirred up by the more than $3 million worth of media messaging paid for by the American Beverage Association (ABA).

In the words of The Washington Post journalist Caitlin Dewey:

While the battle was ostensibly fought by state and county groups, it’s well-acknowledged on both sides that local soda tax skirmishes are essentially proxy wars between the national soda industry and well-monied public health groups.

The ABA also hired people, at a reasonable $11 per hour, to circulate petitions. In some areas, the Can the Tax gang knocked on doors urging area residents to pester their commissioners to repeal the soda tax. Public opinion became so inflamed that amid what was described as unprecedented pushback, the Board of Commissioners reversed their original vote and made the tax go away.

Undeserved financial pain

The conflict left scars, and several soda tax-related lawsuits are still making their way through the courts. The giant Costco chain claimed that its soda sales dropped by 34 percent when the tax was in effect. As might be expected, stores just outside the county line reported a 38 percent increase in soda sales.

This is a clue that location is an important determinant for success. If, for instance, Hawaii were to enact a statewide soda tax, there would be no driving to the next state to stock up.

Compliance with the law extracted a high price from some entrepreneurs, as business owner Daniel Stein told Chicago Tribune reporters Greg Trotter and Becky Yerak. When they talked, the damage to Stein’s business was already up to $75,000 and was poised to mount higher, once lost sales were figured in.

The worst expense was paying for the recalibration of some 850 vending machines — an outlay that was replicated, when the tax was repealed, by the need to send the technicians back into the field to reset the machines again.

The bureaucracy had counted on raking in an extra $200 million this year, which won’t happen now. Board of Commissioners president Toni Preckwinkle warned that local government agencies, like the county clerk, state’s attorney and treasury, would face budget cuts. This means layoffs and hiring freezes in those departments, and of course, fewer public servants available to meet the needs of the public.

At the municipal, county, and national levels, the United States is no longer in the era of “Tax me, so America can have nice things.” This is the dawning of the age of “Tax me, so the little I have will not be taken away.”

Where does the money go?

Strangely, no one seems to suggest saving money by controlling the brutal instincts of the sheriff’s department, jail system employees, and others who cost the county a lot in settlements paid out to citizens who have suffered civil rights transgressions including deadly violence. A single injured prisoner was awarded $4.5 million, and another person won $5.6 million in a wrongful prosecution case.

In the past two and a half years, the sheriff’s department alone paid $25 million in legal settlements. The county was ordered to pay a staggering $32,500,000 to the members of a class action suit over things done in the jails.

A lot of taxpayer dollars could have been put to better use such as, to name just a few possibilities, obesity prevention and treatment and diabetes prevention.

Your responses and feedback are welcome!

Source: “Why Chicago’s soda tax fizzled after two months — and what it means for the anti-soda movement,” WashingtonPost.com, 10/10/17
Source: “Cook County retailers cheer soda tax repeal: ‘This was a nightmare’,” ChicagoTribune.com, 10/11/17
Source: “Cook County Commissioners Sour on Sugary Drinks Tax,” WTTW.com, 10/10/17
Photo by TheToch on Visualhunt/CC BY-SA

Chicago vs. Soda Tax

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Childhood Obesity News noted the objections of a Chicago citizen whose photo of the sales receipt for a pack of sodas went viral. What else might be in store for consumers of sugar-sweetened beverages?

Chicagoan Fred Emke recommended a measure that, given the rationale behind the soda tax, makes a certain amount of satirical sense. His facetious recommendation was to tax several of the most renowned fattening food items — “A penny a chip, a penny a French fry, or a penny per pepperoni.” Emke went on to say:

When you buy a 32-ounce sports energy drink for 79 cents and you get hit with a 32-cent tax, it’s time to travel outside of Cook County to get your pleasure. Let’s hope all of county government officials dine on kale and water during their sessions to find other ways to tax us back to a healthy life!

The whole topic inspired many public outbursts, like the letter that Richard Clemens sent to the Chicago Tribune which concurred that going to Indiana to take advantage of its 7 percent sales tax and absence of soda tax was well worth the trip. He also articulated the taxpayers’ unwillingness to be taken advantage of:

I refuse to spend anymore of my hard-earned money here in Cook County… I would like to see how much of this tax money actually goes toward programs to help fight childhood obesity and diabetes.

In another letter to the editor, Robert Kandelman wrote:

Anyone can see that the Cook County soft drink tax is nothing more than a money grab. If the tax is intended to promote better health choices, why not tax lack of exercise or bad posture?

For Reason magazine, Christian Britschgi explained how people were still upset about the 2016 increase that jacked up the sales tax to a lavish 10.25 percent, the highest in the land. And then property taxes rose by a devastating 10 percent. Britschgi suggested that the soda tax profit would not be used for anything the people of Chicago would willingly pay for.

Instead, it would just service the crippling debt caused by, among other things, the city’s obligation to pay retired employees their pensions. Conclusion: “The county has gone searching for creative ways of bilking citizens.”

Letter-to-the-editor writer Kandelman recalled that when it was first proposed, Toni Preckwinkle, the Cook County Board President, touted the soda tax as a weapon to fight obesity, diabetes, and tooth decay. Also, it was advertised as benefitting lower-income families, by limiting the amount of sugar-sweetened beverages they could afford. Yet, the tax would not be collected from SNAP (food stamp) recipients.

Many people said negative things about the perceived hypocrisy. This wasn’t about people’s health, or children’s health, or anybody’s health, really, except for the budget, and people don’t like to be lied to about such matters.

Then, when the tax was threatened by a lawsuit and a restraining order, officials cast aside all pretense of intent to raise money to fight obesity. Preckwinkle admitted frankly that the purpose of the tax was to fill holes in the general budget. To make her point, she warned that unless it became law, many county employees would have to be laid off. Britschgi wrote:

Preckwinkle has at least been more honest about the tax, saying “we chose as a revenue generator a sweetened beverage tax… both for the revenue and for the health benefits. But first and foremost, for the revenue.”

To both hypocrisy and this admirable transparency, the public reaction was equally sour.

Your responses and feedback are welcome!

Source: “Why stop with soda? Cook County could tax chips, candy and pizza, too,” ChicagoTribune.com, 08/24/17
Source: “Letter: Cook County soda tax: For health or for profit?,” ChicagoTribune.com, 09/08/17
Source: “Cook County Will Repeal Soda Tax,” Reason.com, 10/09/17
Image source: niloo138/123RF Stock Photo

The Chicago Soda Tax Attempt

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While various soda tax battles were being waged in California, Colorado, and other states, Illinois entered the fray with a saga worthy of a TV mini-series. Cook County, which is mainly Chicago, proposed a one-cent-per-ounce tax that would pull in $560 million per year.

A burning question was whether Cook County’s hundreds of thousands of SNAP (“food stamp”) recipients would have to pay. Eventually, a court action quashed that notion. But it was one of the sore points that alienated large segments of the public, because of the uncertainty about a detail that should have been made clear from the start.

Presumably, the public servants who wanted the tax would have studied how it was done in other places, so they might anticipate the stumbling blocks in the process. The taxing of soft drinks is supposed to have a deterrent effect, so consumers will buy less soda, and thus avoid obesity.

But since the SNAP question was brought up, it alerted the public to the fact that the tax would not be collected from SNAP recipients. This supplied plenty of opportunity for critics to point out that the poor are the most at-risk for obesity, so what’s the point of taxing everybody else except them?

For the Chicago Tribune, Greg Trotter wrote:

The study estimated the tax would prevent 116,000 cases of obesity and cause a $733 million decrease in health care costs over a 10-year period. The study, part of the broader, ongoing Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) at Harvard, models the impact of the tax in Illinois.

Illinois said yes to the soda tax, but the Illinois Retail Merchants Association (IRMA) petitioned the court for a temporary restraining order, on grounds of unconstitutionality and vagueness, which is a vague way of saying that the tax would hurt beverage sales. The judge who was scheduled to hear the case recused himself for some reason, perhaps unwilling to deal with one of IRMA’s objections, the thorny issue of uneven application of the law. The problem was:

Retailers also have noted they must either charge customers tax on the ice in fountain drinks, unless they fill out paperwork to designate how much ice each cup holds. Complicating matters, most fast food restaurants that serve fountain drinks allow customers to decide how much ice to put in their drinks.

A different judge took the case, upheld the ordinance, and removed the temporary restraining order. Beneath a headline that called the soda tax “insane,” journalist Jack Burns described this latest outrage perpetrated against the sugar-sweetened beverage corporations. Cook County, upset at the delay in revenue collection, sued IRMA for the millions that the restraining order had prevented the government from making in the interim.

There was some support for IRMA on grounds of general principle, that principle being that there is a “chilling effect” on parties who want to sue the government, when they know that losing might cost them money. The reporter referenced a citizen who bought a 24-can pack of 12-ounce sodas and compared the “before” price ($5.99) with the “after” price ($9.66), with the after price including $2.88 for the soda tax, and the customary 10.25 percent sales tax added in there too.

It is interesting that retail websites currently offer that same pack of 24 sodas for $13, $14, and even $20. The Chicago purchase given as a horrible example was only last year, so what’s up with that stunning price differential? It is also interesting that the quoted citizen’s Facebook timeline is full of heart-warming photos of him with various grandkids — the very demographic that the soda tax hopes to protect from a life of obesity.

(To be continued…)

Your responses and feedback are welcome!

Source: “Illinois soda tax could cut health costs, raise $561 million in revenue annually,” ChicagoTribune.com, 04/25/17
Source: “Hearing on Cook County Sugary Beverage Tax Delayed,” CBSLocal.com, 06/28/17
Source: “Chicago’s Insane Soda Tax Shows What Happens When Crooked Govts Collapse — They Rob the People,” DCClothesLine.com, 08/08/17
Photo by Miran Rijavec (Artist of doing nothing) on Visualhunt/CC BY

Soda Tax Considerations

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Recently, Childhood Obesity News caught up on the soda tax-related doings in California and Colorado, and learned things about the deep-pocketed beverage industry, its representatives, lobbyists, and allies. When the Center for Science in the Public Interest totaled up the amount of money spent from 2009 to 2016 — on trying to prevent state and local efforts to impose a soda tax — they came up with a grand total of $67 million. During that time, the money has bought victory for the industry in 40 instances where a state or city tried to make a tax happen.

For instance, Albuquerque, New Mexico, made a stab at passing a soda tax, with the very specific purpose of using the money to enroll an additional 1,000 children in preschools. The Bloomberg political machine kicked in $1.1 million to support the measure, but the American Beverage Association spent $1.3 million to prevent it from happening.

The industry lobbyists have some unfortunate facts on their side, gleaned from a federal study performed by the Joint Congressional Committee on Taxes. Their research showed that while the soda tax might cause some people to lose weight, they would not be the people most in need of protection: namely children, teens, and low-income folks.

In examining the soda tax concept, writer Thomas A. Hemphill summed up the major publicly proclaimed arguments on both sides. Necessarily it is a gross simplification, because in every city, the contending parties have their own local concerns and agendas:

A soda tax internalizes the negative externalities of market activities — in this case the “public” health costs of obesity and other diseases — by assessing at least a portion of these costs to consumers or soft drink manufacturers. Soda taxes are also flat taxes, thus regressive in nature, negatively impacting lower-income consumers.

Let’s look at those one at a time. The rationale for a soda tax is that money can be spent on anti-obesity measures and on treating people who have diabetes, etc. In reality, the money often goes to all kinds of things, and the citizens rightfully feel like they have been fleeced.

Wolves in sheep’s clothing

Then there is the argument that the soda industry rolls out when it wants to appear altruistic and righteous. More than the middle class or the wealthy, a soda tax hurts the poor. But apparently this is only true of some low-income people, because SNAP (food stamp) recipients are not taxed for grocery purchases.

A common-sense but probably politically incorrect reaction might be, “Well, fine. If poor people can’t afford soda pop, their health will be the better for it. What’s wrong with that?” Regrettably, several more sub-arguments can then be formulated.

The writer points out that the Berkeley, California, soda tax was the first law of its kind to be created through a referendum, and passed with a 76 percent plurality. He praises San Francisco’s bountiful amount of public information and education because if it works, it should be “encouraged for implementation by other local governments in lieu of a SSB [sugar sweetened beverages] tax.”

Your responses and feedback are welcome!

Source: “Spyware’s Odd Targets: Backers of Mexico’s Soda Tax,” NYTimes.com, 02/11/17
Source: “Soda Tax Update: Santa Fe Rejects, Seattle Considers,” BevNet.com, 05/05/17
Source: “PepsiCo: The Soda Tax Is The Opportunity,” SeekingAlpha.com, 05/14/17
Source: “Soda taxes: Regressive and unnecessary,” RealClearPolicy.com, 02/14/17
Photo by TheToch on Visualhunt/CC BY-SA

Soda Tax — How Goes It?

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The city of Davis, California, had a healthy families initiative that succeeded in passing an ordinance to make milk and water the “default options” for children’s meals served in restaurants and fast food outlets. But then Mayor Dan Wolk seemed to lose interest, and disappointed many constituents by not pressing for a soda tax. Despite his professed desire to institute some kind of tax to pay for parks and recreational facilities, sugar-sweetened beverages did not strike him as the appropriate source of revenue for this purpose.

Although this is probably totally unrelated, industry lobbyists had spent over $400,000 in the previous year, making campaign contributions to politicians who believed that any taxing of soda would be a bad idea. Early last year, an attempt was made to tax soda, but the public wasn’t having it. Even the suggestion to label high-sugar beverages was shot down.

This was despite the fact that Mayor Pro Tem Robb Davis called obesity “the public health crisis of our time,” and spoke quite eloquently, as quoted by journalist David M. Greenwald:

The challenge of sugar beverages is quite simple, they’re a delivery mechanism. They deliver fructose to the liver in probably the most efficient means of doing so. Quickly. And rather than being cleared by the liver, that sugar stays there and is turned into fat and that fat and the inhibition of fat burning that goes along with it, means that all the precursors of diabetes, heart disease and coronary artery disease — the genesis is occurring in that location.

Elsewhere in California, the Bay Area cities of Oakland, San Francisco, and Albany were gearing up for an anticipated November 2016 vote on whether to tax soft drinks at one cent per ounce. The beverage industry also prepared, by broadcasting nearly $10 million worth of anti-tax television ads. They had only spent a bit over $4 million on trying to prevent Philadelphia’s soda tax. In comparison, they spent a whopping $21 million attempting to convince San Francisco voters to see things from the soda manufacturers’ perspective.

At the same time Colorado, a state that is home to lots of super-fit people, decided to go backwards when the Board of Education rescinded the ban on diet soda that public high schools had experienced since 2009.

Meanwhile, the Colorado city of Boulder placed an initiative on its ballot which would institute a soda tax, and the American Beverage Association (ABA) somehow managed to fool business owners into joining an anti-tax campaign that many subsequently resigned from. Possibly some of the merchants changed their minds because of a Harvard University study with a 10-year outlook that predicted 1,000 fewer deaths and $6.4 million less in health care costs during the upcoming decade.

Last November — despite the ABA and the corporations having raised their yearly budget for fighting the soda tax in America to almost $38 million per year — Boulder voted for a soft drink tax of two cents per ounce, and the three California cites all voted for one cent per ounce.

Your responses and feedback are welcome!

Source: “Industry Successful in Killing Statewide Soda Tax without a Vote,” DavisVanguard.org, 04/13/16
Source: “Big Soda Spends Millions On ‘Unethical’ San Francisco Area Ads Fighting Drink Taxes,” HuffingtonPost.com, 08/24/16
Source: “The Soda Industry’s Panicked Downward Spiral,” OrganicAuthority.com, 11/08/16
Source: “Colorado education board considers lifting ban on diet soda in schools,” DenverPost.com, 09/14/16
Source: “Jim Martin: Big Soda’s latest scam,” DailyCamera.com, 09/27/16
Source: “In a devastating blow to the beverage industry, four cities passed soda taxes,” Vox.com, 11/09/16
Photo by TheToch on Visualhunt/CC BY-SA

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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