Michael Bloomberg has been called a lot of things. Among them is “nanny-in-chief,” a nickname he earned through his unprecedented public health efforts. While smoking is down in the city, the results are mixed when it comes to his obesity prevention campaign.
Obesity has been a pet issue for Bloomberg, and over the years, he’s made headlines with his prevention tactics: a ban on trans-fats, mandated calorie counts on fast food menus, a years-long advertising campaign aimed at educating the public on obesity and an attempted ban on sugary drinks over 16 ounces.
“We have a responsibility as human beings to do something, to save each other, to save the lives of ourselves, our families, our friends, and all of the rest of the people that live on God’s planet,”-Mayor Michael R. Bloomberg
According to the Department of Health and Mental Hygiene, 24 percent of adults in the city are considered obese, up from 18 percent in 2002. This reflects a national trend: The Center for Disease Control reported 30 percent of Americans were considered obese in 2000. By 2010, the number rose to nearly 36 percent.
“We have a responsibility as human beings to do something, to save each other, to save the lives of ourselves, our families, our friends, and all of the rest of the people that live on God’s planet,” Bloomberg said in a March 11 press conference.
To that end, Bloomberg’s made strides when it comes to smoking. Through the passage of the Smoke Free Air Act in 2003, city subsidized smoking cessation, steep taxes and graphic advertising; smoking has dropped from 21 percent to 14 percent among adults, according to the Department of Health. The mayor’s office says an estimated 10,000 smoking related deaths were prevented by these measures.
But when it comes to obesity, the numbers are not as promising.
Bloomberg’s Anti-Obesity Ads
A PUBLIC HEALTH CAMPAIGN IN THREE PARTS
Cut the Calories
In 2007, Bloomberg had the fast food industry in his crosshairs. The Board of Health, comprised entirely of mayoral appointees, introduced a regulation requiring fast food restaurants to display calorie counts on menus.
In response, the New York State Restaurant Association sued the city, accusing the Board of Health of infringing on the First Amendment rights of fast food companies. The rule was upheld in federal court, making New York the first city in the country with such a regulation.
The legal flap surrounding the proposed soda ban, shot down by State Supreme Court Judge Milton Tingling on March 11, is similar to the controversy that surrounded the posting of calorie counts. No doubt emboldened by the court victory against the New York State Restaurant Association, the city filed for an appeal within 24 hours of Tingling’s decision.
“Being the first to do something is never easy,” Bloomberg said in a press conference that day. “When we began this process, we knew we would face lawsuits.”
An appeals court has agreed to hear the case during the first week of June.
Ban the Transfats
While calorie counts were debated in court, the Department of Health turned its attention to transfats. A public awareness campaign, launched in 2005, proved ineffective as far as curbing the rate of transfat use in restaurants, so the department sought regulation.
In December 2006, the Board of Health voted to impose a restriction on transfats.
By August 2008, the regulation was in full effect, and restaurants had to be rid of the stuff. The city’s regulatory stance against transfats marked another first in the nation.
Video: Michelle Matthews discusses the obesity ads
Michelle has lived in New York for four years. When she gets on the subway and sees one of those ads, how does that make her feel?
The Shock Approach
Since 2005, public awareness campaigns accompanied each of the city’s major public health initiatives. In 2011, however, things got a little messy.
The Department of Health unveiled its grisly “Pouring on the Pounds” campaign, aimed at getting New Yorkers to put down the soft drinks. A television ad, not for the weak-stomached, has an actor sucking back a glass of pure, golden-yellow fat.
Another wave of ads in 2012 focused on portion control, featuring real New Yorkers, who were considered obese. They were riding motorized scooters and missing legs. In the foreground appeared hamburgers, fries and soft drinks, with text calling for smaller portions, or this, the ads implied, could be you.
The shock approach spoke volumes to some.
“It causes a stir. It gets attention. That’s when you get action,” said Amy Shapiro, founder of Real Nutrition NYC, a nutrition counseling and weight management practice.“I don’t think it’s the worst thing.”
But not everyone was scared straight.
“If this is a public health campaign, then we should be talking about health, not appearance,” said Golda Poretsky, a health coach and self-proclaimed “fat activist.” “And the whole idea that you can eat healthy and exercise and you’ll be thin is a total and complete fiction.”
THE EVIDENCE: Did it work?
Bloomberg is a man who likes data. But as far as obesity goes, the numbers are not on his side.
At least three studies, published between 2009 and 2011, found no change in the purchasing habits of New Yorkers since the calorie count regulation went into effect. “We found no statistically significant differences in calories purchased before and after labeling,” one study noted.
“If this is a public health campaign, then we should be talking about health, not appearance.”-Golda Poretsky, health coach
Meanwhile, the effects of the ad campaigns are difficult to measure. Surprisingly, two outspoken critics of the ads happen to be models who appeared in them. Singer Beth Anne Sacks told The New York Times last year that she knowingly posed for an ad, while actor Cleo Barry had posed for a stock photo agency, which later sold the photo to the Deptartment of Health. The department photoshopped his leg off for an ad about diabetes. Neither Sacks or Barry could be reached for comment.
Many health advocates like coach Poretsky, think the city should shift its focus to health choices, and avoid targeting weight all together. “All we’re doing is stigmatizing people,” she said. “When you make it about healthy lifestyle choices, you don’t stigmatize anybody, and you get across the message you’re getting across.”
Porestky specializes in what’s called “Health at Every Size,” a school of thought which emphasizes healthy habits without a focus on weight loss. “Very simply, it acknowledges that good health can best be realized independent from considerations of size,” wrote Linda Bacon, Ph.D., in her book Health at Every Size: The Surprising Truth About Your Weight.
“This whole thing that obesity’s so bad,” Poretsky said, “so if you’re thin then you can eat whatever you want?”
She added that pushing obese people to lose weight takes a toll not only on their self-image, but is unsustainable. There is a growing body of research to support her claim. A 1992 research study found that within five years, those participating in weight loss programs regain nearly all the weight lost. Another study, in 2001, had similar results
“So, really, body weight is not just a matter of individual will or control,” said Dr. Zoe Meleo-Erwin, professor at the Hunter School of Public Health.
Rebecca M. Puhl, Ph.D., and Chelsea A. Huer, MPH, note in a 2010 study that attaching a stigma to a health issue, like obesity, can take a negative toll on a person’s mental health.
“Stigmatization of obese individuals threatens health, generates health disparities and interferes with effective obesity intervention efforts,” they write.
Health blogger Amy Nowacoski has mixed feelings. She runs a blog called “Fat Girls Can Run.”
“If you look at any of the weight loss companies like Weight Watchers, they only show success stories,” she said. “If obesity campaigns went that way and showed you the benefit, I think that would be helpful.”
Many health experts, like Dr. Meleo-Erwin, also argue that the ads merely apply Band-Aids to larger issues.
“We would need to address a dearth of affordable, fresh, whole foods in urban areas. It would look like having safe, outdoor areas for exercise,” she said. “Quite frankly, it would also be a labor issue. It would be doing things like increasing the minimum wage to a living wage so that people could actually afford to eat good foods, to afford leisure time in which they exercise and could purchase the things they need for that exercise, like a gym membership or a bicycle or something like that.”
That’s not all. She points to a larger problem with the ads.
“If you look at some of the mayoral campaigns, it’s clear that they’re targeting certain populations,” she said, noting ads often feature women and people of color. “Then there are some of those things that say, ‘if you wanted to burn off the calories from one Coca-Cola, you’d have to walk from Yankee Stadium to Harlem. Anyone in New York City can read that as a coded racial and class message too, because we know which populations are being talked about there.”
With Bloomberg’s long tenure coming to a close this fall, the next mayor will be at the reins of the Board of Health, and it will be up to him or her to decide the health priorities of New Yorkers. The campaign could be ramped up, or it could be scaled back to make room for other public health concerns. One thing is certain: if there’s fat to be trimmed, more than a few New Yorkers will notice.
HOW DO YOU FEEL ABOUT BLOOMBERG’S APPROACH TO OBESITY? SHARE YOUR THOUGHTS IN THE COMMENTS BELOW.