28 Oct – New York – In the midst of a legislative fight over taxing sodas last year, the New York City health department put together a media campaign about how drinking a can of soda a day “can make you 10 pounds fatter a year.” But behind this simple claim was a protracted dispute in the department over the scientific validity of directly linking sugar consumption to weight gain — one in which the city’s health commissioner, Dr. Thomas A. Farley, overruled three subordinates, including his chief nutritionist.by ANEMONA HARTOCOLLIS New York Times
“CAUTION,” the nutritionist, Cathy Nonas, wrote in a memorandum to her colleagues on Aug. 20, 2009. “As we get into this exacting science, the idea of a sugary drink becoming fat is absurd.” The scientists, she said, “will make mincemeat of us.”
But Dr. Farley argued that the advertisements had to have a message that would motivate people to change their behavior. “I think what people fear is getting fat,” he wrote.
The dispute, reflected in unusually candid internal e-mails, reveals a health commissioner with a high tolerance for dissent, yet committed to fighting obesity, a passion shared by Mayor Michael R. Bloomberg. The soda tax proposal was eventually dropped from the state budget, but the mayor escalated his antisoda campaign this month by requesting permission from the federal government to bar city residents from using food stamps to buy sodas and other sugar-sweetened beverages.
But the e-mails, which were obtained by The New York Times under the state’s Freedom of Information Law, also show what happens when officials try to balance science and public relations and toe the line between disseminating information and lobbying for a cause.
Few would argue that soda is nutritious, and there is a body of evidence showing a high correlation between rising obesity in the United States over the past 30 years and a parallel rise in the consumption of sugar-sweetened drinks. It is also possible to calculate the conversion of calories into fat, as the health department did in developing its advertisement.
But Ms. Nonas, along with at least two of her colleagues and a Columbia University professor they consulted, expressed strong doubts about the weight-gain message of the video and urged the department to rethink it. They pointed out that, on an individual basis, the conversion of calories into fat depends on factors like exercise, genes, gender, age and overall calorie consumption.
“Basic premise doesn’t work,” Dr. Michael Rosenbaum, a professor of pediatrics and clinical medicine at Columbia, said in an e-mail to Ms. Nonas on Aug. 18, 2009.
The advertising campaign, called Pouring on the Pounds, was developed by an advertising agency, Bandujo, in consultation with city health officials. City officials wanted the campaign to have, in the words of one of them, a “major gross-out factor” that would make the video “go viral” on the Web. The campaign produced a print advertisement for 1,500 subway cars showing fat tumbling from a soda bottle, but without the direct weight-gain claim. The video, which has been viewed more than 700,000 times, shows a young man sucking down fat from a can as it dribbles down his chin to a cheery calypso-flavored tune.
It was the video that sparked the dispute, with its claim: “Drinking 1 can of soda a day can make you 10 pounds fatter a year. Don’t drink yourself FAT.”
The video’s release was delayed for months. Geoffrey Cowley, the communications director for the department, said that it had decided to release the video separately, and that the disagreement did not cause the delay.
Mr. Cowley, who had sided with Dr. Farley, said this week, “We took into account what they were saying and came up with a phrase that everybody could live with.”
Ms. Nonas said this week that she was satisfied with the video. “It’s totally supportable to say ‘can,’ ” she said.
Early on, the e-mails showed, there was discussion about whether the fat looked too much like a “strawberry smoothie” and whether one of the drinks contemplated for the advertisements — orange juice — would provoke ridicule.
Then, on July 1, 2009, Sabira Taher, who holds a master’s degree in public health and is the campaign manager for health media and marketing for the department, wrote to Ms. Nonas raising doubts about the video’s message.
“I think Dr. Farley really wants to say something about ‘gaining 15 pounds of fat in a year,’ ” Ms. Taher wrote. But she had reservations. “We know gaining and losing weight isn’t that cut and dry — some people can drink and eat whatever they want and still maintain their weight without doing an incredible amount of exercise to burn off the extra calories. I think going this route would raise a lot of skepticism within the public about our message.”
Ms. Nonas agreed and was joined by Jeffrey Escoffier, the department’s director of health media and marketing.
Ms. Nonas sought advice from Dr. Rosenbaum. “The commissioner would like to say, ‘like making you gain up to 15 pounds a year,’ but that’s such a stretch and brings some idea of reality (but not pure science) into something that’s so exaggerated,” she wrote.
Dr. Rosenbaum replied that a more accurate number would be 10 pounds. But beyond that, he added, the underlying assumption was flawed because “you would need to make the case that you are talking about a can of soda more per day relative to energy expenditure.”
The argument was becoming too sophisticated to convey in a simple advertisement. “The science absolutely weakens our potential for mass distribution,” Ms. Taher wrote.
She advocated sticking with the gut-level appeal of the “goopy fat images.” “This is what viral marketing is all about,” she wrote in an Aug. 19, 2009, message to Ms. Nonas.
As Dr. Farley and Mr. Cowley pushed back, Ms. Nonas tried to come up with a compromise. What was “defensible?” she asked in an e-mail to Harvard and Columbia professors. “What can we get away with?”
Steven L. Gortmaker, professor of the practice of health sociology at Harvard, suggested it might be safe to say that a year of daily sodas for a typical 10-year-old would lead to a five-pound gain, leveling off at nine pounds over time.
But Dr. Farley had the final word. “I understand that there is inter-individual variation and the experts’ caution,” he wrote on Aug. 20, 2009. “But I think what people fear is getting fat, so we need some statement about what is bad about consuming so many calories.”
Dr. Farley said he had reviewed other studies, a couple of them “quite old,” that “within the margin of error” would support the idea of a gain of 10 to 15 pounds. “So I favor the 10 pound sentence, but maybe keeping even a little more wiggle room,” he wrote.
He suggested less certain language, saying that soda “can make you gain” weight, and he proposed a disclaimer at the end, along the lines of “assuming no other changes in diet or physical activity.”
Just before the video went up, Ms. Nonas sent another message to Dr. Rosenbaum, explaining what the video would say. “I think this is broad enough to get away with,” she wrote. But she wanted to know “what the guru thought.”
Dr. Rosenbaum wrote that the advertisement was “misleading in that there is no reference to energy output changes.” The disclaimer Dr. Farley had proposed about diet and activity had been dropped.
If Ms. Nonas or Dr. Farley took Dr. Rosenbaum’s caveat to heart, it is not evident in the e-mail provided by the city. “It looks as if we got the go-ahead from City Hall to release our video on Pouring on the Pounds,” Ms. Nonas wrote to a Yale professor on Dec. 11. “It’s deliciously disgusting.”
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Tags: Bandujo, Cathy Nonas, drink yourself fat, fat, Geoffrey Cowley, health department, Jeffrey Escoffier, Michael Rosenbaum, pouring on the pounds, Sabira Taher, soda, Steven L. Gortmaker, tax, Thomas A. Farley