Reducing Sugary Drink Consumption:Reducing Sugary Drink Consumption:A Public Health PriorityA Public Health PriorityA Public Health PriorityA Public Health Priority

February 20, 2014Roberto Ariel Vargas, MPH, UCSF Ch i i G MPH SF DPHChristina Goette, MPH,  SF DPH

Percent of Children (Ages 2‐11) and Adolescents (Ages 12‐17) Drinking At Least One Sugar‐Sweetened Beverage per17) Drinking At Least One Sugar Sweetened Beverage per 

Day in 2005‐07 and 2011‐12, by Race/Ethnicity

Consumption ofConsumption of sugary drinks for young children

Consumption of sugary drinks for adolescents among all ethnic/racial groups except Whitesgroups except Whites.

SF Adult Soda Consumption & SF Adult Soda Consumption & Overweight/Obesity by RaceOverweight/Obesity by Race

75

6870

80Overweight/Obesity by RaceOverweight/Obesity by Race

50

55

60

50

60

29

43

2929

43

30

40

10

20

0

10

Source: 2009 and 2011‐12 California Health Interview Surveys (Adult)

SODA EXPENDITURES Percent of Total Expenditures, National Rank by Tract (2011)

TENDERLOINTENDERLOIN

MISSIONMISSION

BAYVIEWBAYVIEW

VISITACIONVISITACION VALLEYVALLEY

EXCELSIOREXCELSIOR

What Happens to Sugar in our Bodies?What Happens to Sugar in our Bodies?• Sugar suppresses our body’s ability to burn fat.

What Happens to Sugar in our Bodies?What Happens to Sugar in our Bodies?

• Added sugars are metabolized differently than natural sugars and converted into fat by liver.natural sugars and converted into fat by liver.

• Too much sugar alters our hunger response.T h lt th d t i• Too much sugar alters the reward center in our brains; similar to alcohol, cocaine, nicotine, and other addicti e s bstancesother addictive substances.

We eat too

much sugarmuch sugar

Sugar rush

Leptin resistancetriggers overeating

Sugar crash

Insulin resistance

Saps energyWeight gain

No energy to

exercise

The Biggest of the Big GulpsThe Biggest of the Big GulpsThe most outrageous soda sizes ever sold, by franchiseThe most outrageous soda sizes ever sold, by franchise

King Size Great Supersize  gBurger King42 oz

Biggie Wendy’s 42 oz

McDonald’s 42 oz

* Calculations based on a 12 oz cola that has ~10 tsps of added sugars.

~ 6 ~ 6 tspstsps

~10 ~10 tspstsps ~35 tsps~35 tsps

~53 tsps~53 tsps ~70 tsps~70 tsps ~83 tsps~83 tsps >100 tsps>100 tsps

Source: Company websites

Healthy food prices soar, i l i l hsweets remain relatively cheap

Beverages contribute l h lf f llnearly half of all 

added sugars d b thconsumed by the 

average American each yeareach year.

Energy fromEnergy from beverages adds to daily caloric intake yand does not displace calories from food.

Soda Consumption/OverweightSoda Consumption/Overweight50018

Soda Consumption/OverweightSoda Consumption/Overweight

350

400

450

14

16

250

300

350

10

12

L/da

y

over

wei

ght

child overweight

sweetened drink

150

200

6

8 mL

% c

hild

o sweetened drink consumption

50

100

2

4

001960s 1970s 1980s 1990s

Data sources: National Soft Drink Association, Beverage World (Jacobson, 2001) and Center for Weight and Health, University of California, Berkeley

Health Impacts of Drinking Liquid SugarHealth Impacts of Drinking Liquid SugarHealth Impacts of Drinking Liquid SugarHealth Impacts of Drinking Liquid Sugar

On average, Americans g ,consume 22 teaspoons of added sugar a day. A i HAmerican Heart Association recommendations for added sugars:

99 66 33

14

To give some perspective…To give some perspective…To give some perspective…To give some perspective…

10 teaspoons of sugarp g

Health Consequences of Drinking Li id SLiquid Sugar

Mountain Dew Drinker Diet Soda Drinker

www.thebiggerpicture.orgwww.thebiggerpicture.org

Parallels to the Tobacco Industry…Parallels to the Tobacco Industry…Parallels to the Tobacco Industry…Parallels to the Tobacco Industry…

• Targeted Marketing• Targeted Marketing• Influencing Scienceg• Lobbying• Public Relations• Trade Groups• Trade Groups• Voluntary Self‐Regulation

Targeting Black and LatinoTargeting Black and LatinoChildren and TeensChildren and Teens

• Beverage companies view Latino and blacks, and teens as a source of future growth for sugary drink product sales.

• Black children and teens saw 80% to 90% more ads compared with pwhite youth.

• Marketing on Spanish‐language TV is growing. From 2008 to 2010, Hispanic children saw 49% more ads for sugary drinks and energy drinks, and teens saw 99% more ads.

• Hispanic preschoolers saw more ads for Coca‐Cola Classic, Kool‐Aid, 7 Up and Sunny D than older Hispanic children or Hispanic teens did.

Soda companies use philanthropy strategically to:

• Link their brands to health• Link their brands to health and wellness

• Create partnerships with GOAL: To increase brand awarenessGOAL: To increase brand awarenessp prespected health and minority

GOAL: To increase brand awareness GOAL: To increase brand awareness and brand loyaltyand brand loyalty

• Garner public trust and goodwill

• Court growing minority

y yy y

• Court growing minority populations to increase sales and profitssales and profits

Celebrity EndorsementsCelebrity Endorsementsyy

New and Social MediaNew and Social MediaPepsi Refresh $1.3 million to grassroots orgs in 2010

Social VendingSocial Vending

SF HIP Physical Activity and Nutrition (PAN) Partnership Working Group (PWG) Logic Model: Physical Activity in the Healthy Eating Active Living (HEAL) Zone

Problem StatementThe Bayview Hunters Point (BVHP) community has less open space than most communities in SF.  There is a large park in the center of BVHP that is under‐utilized.  A primary reason people are less active in BVHP is because they feel unsafe outside.  Resident surveys identify that community members want to see more physical activities with high visibility in the neighborhood.

Inputs/Assets Activity Intermediate OutcomesImmediate Outcomes ImpactOutput MeasuresInputs/Assets Activity Intermediate OutcomesImmediate Outcomes Impact

Decrease in obesity i BVHP

Sense of public safety is increased in the BVHP

Improved lighting and physical improvements to BVP

HEAL Zone (HZ):•Staff•Residents•grantees

Establish formal partnership  between Parks 94124 and SF Park and Recreation Dept.

Advocacy base for BV ParkPolicy brief and supplemental material  developed for promoting city $ equity for BV parks

Partnership with Rec. and Park established

Regular walking groups d l titi i t BVP

Output Measures

BVHP:•community‐based organizations  (CBO)•Churches

id t

Convene a planning process for Friends  of Bayview Park 

Park activities  are visible and supervised

in BVHPHZ Community Advisory Members

Improved  quality of  l f (l h l

Physical activity in the BVHP is increased.

# of partners convened for BVP Family & 6 mo. activites

Formal partnership established between Parks 94124, SF Park and 

Bmagic and HZ are identified as committed supporters for the BVP and PA

Friends of the Bayview Park propose policy  that 

and pool actitivies at BVP and MLK Jr. Pool

Recruit partners to commit regularly supervised activities  at BVP

Recreation staffing time is increased in the HZ•residents 

UCSF : CTSI; School of Medicine staff , faculty d l

life (less school missed, less work missed, improved self esteem. Less crime)

Rec, and BV HEAL Zone

Research funding sources for parks broadly and 

p p p ysupports  increased and sustained support for Bayview Hunters Park space

Kaiser Permanente funding Number of organizations 

committed to pilot activities in the BVP

BVP

Connect BVP to CTA Transportation Plan for BVHP

Number of BVHP residents with an increase in daily Physical activity is increased.

Leveraged and new funds to support activity in the BVP i dand learners

SF City and County•County Transportation Authority•SFDPH

o pa s b oad y a dlocally

Environmental Factors

BVP are increased

At least 4 new commitments for long‐term (6mos. or more) physical activities to be provided @  BVP.

Assumptions/ Theories

SF PH•SFPD (academy recruits?)•SF Foundation•SFUSD•Supervisor Cohen•Park and Rec. Dept.

•People who are near parks are more invested in what happens there•We undeveloped open spaces in the BVHP•Turf issues exist, especially between young men•Transportation networks are inadequate for BVHPB i P k (BVP)

Convene partners to develop a transportation plan to increase access to physical activity programs

Transportation plan is produced a

•People have the capacity and time to do this•Social cohesion will be built•Changing the built environment changes behavior•More visible physical activity increases sense of safety•Increased transportation access to recreation and physical activities will increase participation

Supplies  & Materials

•Transportation networks are inadequate for BVHP residents to access existing physical activity programs•Many houseless people frequent the park•There is competition for physical activity and park resources across SF

Bayview Park (BVP) and MLK Jr. Pool

SFHIP 1.0 PAN Policy WorkSFHIP 1.0 PAN Policy Work

• Partner review of policy options for reducing SSB consumptionreducing SSB consumption

• Provide science consultation to local policymakers on evidence‐based optionsp y p

• Information sharing with other health departments, NGOs, policymakers and universities nationally and internationally

• Provide science and legal consultation (UCSF UC Hastings Consortium) to SF(UCSF‐UC Hastings Consortium) to SF policymakers on Sugary Beverage Fee

Current status of UCSF PAN policy Current status of UCSF PAN policy ffffeffortsefforts

• Consultations pending with other jurisdictionsConsultations pending with other jurisdictions• No UCSF position or effort directly for SF Soda Tax through November electionsTax through November elections

• Focus groups with community groups to be i d i hi i h H l h E i /organized in partnership with Health Equity/ 

Parity Coalitions to study community i f IOM li d iperceptions of IOM policy recommendations 

Proposed SF Sugary Beverage TaxProposed SF Sugary Beverage TaxSupervisors Mar, Wiener, Cohen, Avalos and Chiu

$.02 per oz. excise tax on distributors of drinks with more than 25 calories of sweetenersweetener

Special Tax allocated specifically for:

(25%) Rec & Park – Staffing; active recreation supports(25%) Rec & Park Staffing; active recreation supports

(40%) SFUSD – Physical Education, nutrition programs, school food and recreation (during and after‐school hours)(25%) DPH/PUC  – healthy eating and active living programs in the community; health education and 

t h

Healthy Food Access – expanding school nutrition programs, incentivizing healthy retail, water b ttl filli t tioutreach

(10%) CBOsbottle filling stations

Focus on populations most impacted by obesity‐related disease and Sugary i k i i h bDrink consumption; oversight by groupSupervisors presented legislation to full board; goes to committee in MarchSupervisors presented legislation to full board; goes to committee in March

Timing likely: November 2014 ballotTiming likely: November 2014 ballot

State Legislative EffortsState Legislative EffortsState Legislative EffortsState Legislative Efforts

MonningMonningSB1000 HealthHealth Warnings on Sugary DrinksSugary Drinks

How can SFHIP 2.0 helpHow can SFHIP 2.0 helpHow can SFHIP 2.0 helpHow can SFHIP 2.0 help• Adopt Sugary Drinks work as an SFHIP 2.0 campaign• Support ongoing work citywideSupport ongoing work citywide

– data collection and analysis and sharing via www.SFHIP.org (BMI, Physical Activity, SSB consumption)

– support public education campaigns– media buys– evaluation – post the current campaign posters throughout the system/org 

d / k• Be an advocate in your organization/ network– Post a sugar savvy display in central location– Get trained/host info session on sugar savvy to providers/clients

Ad t O i ti l ll li i /B S d F Z– Adopt Organizational wellness policies /Become a Soda Free Zone

ContactContactRoberto Ariel Vargas, MPHNavigator

ContactContact

Community Engagement and Health Policy ProgramUCSF

@f f drvargas@fcm.ucsf.edu

Christina Goette, MPHChronic Disease Prevention ProgramsCommunity Health Equity and Promotion SF Department of Public HealthS epa t e t o ub c ea t415‐581‐2422christina.goette@sfdph.org

The views expressed herein do not necessarily reflect the officialpolicies of the City and County of San Francisco; nor does mentionof the San Francisco Department of Public Health imply itsendorsement