PHILADELPHIA - Doctors treating the casualties of the global obesity epidemic say an unpopular proposal to limit soda portions in New York City should be just the beginning of stricter regulation of unhealthy foods.
Public opinion polls show a majority of Americans oppose New York Mayor Michael Bloomberg's plan to limit single servings of sugary drinks to 16 ounces (0.45 kilograms) at restaurants and other public venues.
Many view the measure as unwelcome government intervention in their daily diets.
But exasperated diabetes specialists say people need even greater protections from a food industry that keeps enticing them with ever-bigger portions, as more than two-thirds of the country's adults are now overweight or obese. Excess weight contributes to health problems from diabetes to hypertension.
"We're spending billions of dollars for drugs to cure the problem after the problem happens, instead of preventing the problem," said Dr. Bryce Palchick, a general practitioner in Pittsburgh.
"This goes beyond individual freedom; if you have diabetes and end up in the hospital, somebody else is paying for your bills if you're not paying for it yourself," Palchick said in an interview at the American Diabetes Association annual meeting in Philadelphia last week. "Not only are you endangering your own life, you're making everybody else pay for it."
Obesity accounts for US$190 billion (S$241 billion) in annual US medical costs - or almost 21 per cent of the total, according to a recent Lehigh University study. On average, obese individuals incur US$2,741 higher medical bills each year than other people do, the study said.
A report presented this week by the American Medical Association estimated that 46 per cent of the nation's intake of added sugars came from beverages. It said increasing taxes on sugar-sweetened beverages to a penny per ounce would lead to a 5 per cent drop in the prevalence of people who are overweight and obese, and cut medical costs by US$17 billion within a decade.
Other medical experts predict the scope of the problem will lead to further restrictions on food portions, from oversized hamburgers to super-size servings of French fries. New York City may be one of the first major centers to adopt new rules and become a template for other regions across the United States, they said.
"It wouldn't be unreasonable to consider other high-calorie and empty-calorie foods" for regulation, said Dr. Andrew Ahmann, a professor of endocrinology at the Oregon Health and Science University in Portland.
He did express concern, however, that such intervention would be most costly to lower-income people, who rely more on the cheaper fare of fast-food restaurants.
Bloomberg's soda proposal might seem a little over-reaching, but makes total sense from a health perspective, said Karen Weiland, a nurse practitioner from Ohio State University Medical Center in Columbus.
"The person gets a huge jolt of sugar, and there's no protein or fat in the soda to mitigate that, and the body's insulin is not equipped to deal with that," she said. "Plus it's adding a lot of calories nobody needs."
Weiland expects New York to regulate other high-fat or high-calorie foods within a year or two and for such restrictions to "go global," as other governments follow suit. However, the proposed soda restrictions face stiff opposition.
Coca-Cola Co has called the Bloomberg proposal an insult to New Yorkers. And the American Beverage Association, which represents that company as well as PepsiCo Inc and other soda makers, is fighting the measure.
The city's Board of Health is expected to vote on the measure by September, after a three-month public comment period. If approved, the regulations would take effect in March. Even so, they could face a court challenge from opponents, including a coalition of the beverage association, the National Restaurant Association, the National Association of Theatre Owners and others.
"We're watching developments, but I can't tell you at this point what we will do" in terms of legal or other strategy, said Gary Klein, general counsel of the theater owners group.
Bloomberg's proposal follows a series of failures by individual US states and local governments to introduce new taxes on sugary drinks. Residents of Richmond, California, will vote in November on a proposed 1-cent-per-ounce tax on sugar-sweetened beverages. The city would use the estimated annual proceeds of US$2 million to US$8 million for soccer fields, school gardens and health programs for children.
Governments abroad have already begun to embrace taxes and other regulation on foods that contribute to weight gain.
Denmark imposed a tax last year on foods containing more than 2.3 per cent saturated fats - lifting the costs of butter by 30 per cent and a bag of chips by 8 per cent. A year earlier, the country had raised excise taxes on chocolate, ice cream, sugary drinks and candy by 25 per cent.
In 2011, Hungary started taxing prepackaged foods high in sugar, salt or caffeine - including carbonated sugary drinks, cookies, jams and instant soups. Finland introduced a tax the same year on sweets, chocolates and ice cream, and raised its existing excise tax on soft drinks.
Belgium, Ireland, Romania, Italy and the United Kingdom have considered similar measures as obesity rates among their citizens catch up to the United States.
Even Tasmania, whose isolation has protected many animal species from extinction since the Ice Age, is succumbing to fast food, said Dr. Gary Kilov, a primary care doctor from the Australian state who attended the diabetes meeting.
"There has been a doubling of childhood obesity in the last decade, and this pretty much reflects what's happening in all the Western world," he said. "Food is cheap, and lives are busy, so we opt for convenience over activity."
Australia now has one of the world's lowest smoking rates after emulating Bloomberg's earlier ban on the practice in bars and restaurants, Kilov said. But the New York big-soda ban does not go far enough, he added.
"To select soft drinks as the sole target of obesity is laughable; it's just fiddling at the edges," he said. "A better option would be an empty-calories tax on sugary drinks and high-fat foods and putting that money back into health and education. Tax your french fries, your doughnuts and ice cream."
Dr. Saleem Qureshi, an endocrinologist from Islamabad, Pakistan, said he wholeheartedly supported Bloomberg's big-soda restriction and expected his country to follow suit.
"It is time for the government to interfere," Qureshi said."It's not about the words 'sugar' or 'diabetes' - it's about the heart attacks, the strokes, the kidney failure, the blindness and the amputations that come from diabetes. And it's hitting at a younger and younger age."