In the last 30 years, U.S. obesity rates have tripled in children and doubled in adults, leading many to compare the public health impact of obesity to that of smoking. Yet while cigarette taxes and indoor smoking bans have been highly effective in decreasing smoking rates, the U.S. has yet to implement similarly effective population-level policies intended to reduce obesity rates. However, New York City (NYC) will soon implement an innovative new policy aimed at addressing obesity at the population level. The city will ban the sale of sugar sweetened beverages (SSBs) in serving sizes >16 ounces at restaurants and other food-service establishments. SSBs, more than other food or beverage group, are strongly associated with obesity. While some policies now limit SSB sales in schools and government-owned buildings, the NYC SSB law will be the first large-scale, population-level policy to target SSB consumption in the US. It is unknown how consumers and suppliers will respond. Consumers may comply with the policy and purchase single beverages d16 ounces. Alternatively, consumers may purchase multiple beverages d16 ounces, shift purchases to establishments that are exempt from the policy, such as grocery stores, or increase consumption of other unhealthy products. Similarly, the restaurant and soda industries may alter the pricing, promotion or placement of SSBs or other beverages, all of which could influence the impact of the policy. The policy has great potential importance to public health, but has been the subject of considerable controversy and industry response. The introduction of this provision provides a rare opportunity to answer important questions about the benefits and efficacy of public policy in attempting to alter consumer behavior. We propose to examine the influence of this policy on NYC adults'calorie purchasing and consumption at fast food restaurants, where the majority of SSBs subject to the policy are sold. Data collection will include point of purchase receipt collection and surveys from fast food restaurant consumers (Aim 1, outcome is total beverage calories), along with follow-up 24 hour dietary recalls of these same consumers (Aim 2, outcome is total calories consumed). To control for secular trends we will collect data from two areas of New Jersey statistically matched to NYC as non-treated comparison communities. In addition, we will examine the impact of the policy on the SSB environment (Aim 3), including beverage availability, size, price, placement and promotion in fast food restaurants. We will also measure the same environmental characteristics in corner and grocery stores, where SSBs are sold without size limitations. Both the consumer survey and environmental assessment data will be collected prior to policy implementation and twice a year for three and a half years after implementation. The 1st year of data collection post-policy implementation will measure the short-term impact of the SSB policy, while the 2nd and 3rd years will address the longer-term impact on beverage calories.
Obesity is one of the most complex and intractable public health problems facing our nation, and much attention is being given to finding effective population-level policies to address this issue. This project will examine the effect of a new policy in New York City bans the sale of sugar-sweetened beverages in sizes greater than 16 ounces in restaurants and other establishments. We will examine the influence on food choice, total consumption and environmental changes. Sugar-sweetened beverages are more strongly linked to obesity than other food and beverage groups, are a risk factor for diabetes and heart disease, and have no nutritional value.