Photo Gallery: Fighting Obesity One Cup at a Time
A Supersized Problem America's Losing Battle Against Soft Drinks
Lloyd Winnecke, the slim mayor of Evansville, Indiana, often watches the "Today Show," a breakfast show broadcast from Manhattan. There is one episode, in particular, that sticks in his mind. It was June 1, and New York Mayor Michael Bloomberg was sitting in the studio looking cornered. It was the day after Bloomberg had announced a plan to ban supersized soft drinks, and now he was on live TV to celebrate National Donut Day, of all things, as the city's official patron.
To commemorate the event, the baked-goods maker Entenmann's was giving away some 2.2 million calories in the form of 7,500 donuts. The irony of Bloomberg's duel involvement with the soda ban and the donut bonanza was just too tempting for "Today Show" host Matt Lauer to pass up: He made the mayor look like a ridiculous hypocrite.
In Evansville, a city in southern Indiana on a bulgy horseshoe bend of the Ohio River, a two-and-a-half-hour flight west of New York City, Mayor Winnecke began his day a little amused and even gleeful. It was yet another day in America's confused war on obesity.
It's clearly a war worth fighting. The enemy is deeply entrenched in the country and wreaking havoc on the civilian population. In Indiana, 65 percent of all adults are overweight or truly, even dangerously obese, and some 30 percent of young people aged 10 to 17 weigh too much or even far too much. Since these extreme numbers coincide with the national average for the United States, they describe a national crisis that is likely to expand to disastrous proportions. In 2030, an estimated 110 million Americans will be obese, an increase of 32 million over current figures. Indeed, some believe that the obesity epidemic could lead to the collapse of the American health care system.
Evansville is a case in point. A Gallup poll conducted last year ranked the city as the most obese in the nation. According to the survey, 37.8 percent of people in Evansville are obese, with a body mass index (BMI) of 30 or more. That's a lot: With a BMI of 30, an 8-year-old boy, 1.3 meters (4'3") tall, weighs more than 50 kilograms (110 lbs), a 40-year-old man, 1.8 meters (5'11") tall, weighs almost 100 kilos (220 lbs), and a 20-year-old woman, 1.7 meters (5'6") tall, weights 87 kilos (191 lbs). In Evansville, these statistical types go by names like Shirley and Steve or Peter and Mary, overweight people made of flesh and blood -- and far too much fat.
A Dubious Distinction
Although it's a very serious issue, and one that government authorities have dubbed an epidemic, it's hard to not chuckle a bit over some aspects of the matter. For example, when some Evansville residents wanted to break the world record for collective pushups, only 165 people showed up, instead of the required 251, out of a population of 120,000. And a video showing the mayor, police officers, firefighters and local ice-hockey stars working out while singing might also make you laugh. But none of this is funny.
"The subject of obesity is toxic in Evansville," says Winnecke, a 52-year-old moderate Republican who has only been in office for six months. The Gallup poll ranking Evansville as America's obesity capital came out in the middle of his election campaign.
Evansville is a respectable and relatively prosperous city. There is a noticeably large concentration of industry in the surrounding area, including a plastic-goods manufacturer with 2,200 employees and a Toyota plant with 4,600. There is a huge sports and entertainment center in downtown Evansville, and the city has an orchestra, a casino, two large hospitals and a wide belt of shopping malls and commercial zones along its periphery. "We always have companies interested in moving here or building new facilities," Winnecke says. "The scouts are constantly coming here to look for good locations. Being called the 'most obese city' doesn't exactly help."
Appearances vs. Reality
To offset that dubious distinction, the city is trying to polish its image. But there is little hope of coming to grips with the underlying problem. "I myself never take the elevator," Winnecke says three times during the course of a Friday morning in mid-July. "I always walk up the stairs." After our meeting, he makes a show of visiting the small farmers' market in deserted downtown Evansville, a forlorn-looking collection of a dozen vendors next to an urban wasteland.
Posing in front of the cameras of local TV stations, Winnecke buys fresh vegetables and fruit, squeezes tomatoes and melons, raves about the smell of fresh basil and thanks the farmers and vendors for being there in the first place. "It's all about raising awareness," Winnecke says, borrowing an expression that you hear a lot in the United States these days. It means believing in the healing powers of a drop on a hot stone and behaving as if there were no reason to despair in the face of a seemingly unsolvable problem.
Signs have gone up at a few intersections in Evansville showing the number of steps to various locations in a city where hardly anyone walks anymore. The fitness video "Go, you chicken fat, go," filmed at Bob's Gym and published on the mayor's YouTube channel, received 3,400 clicks, equal to about 3 percent of the city's population. Winnecke says that there are 65 small and large parks in the city, "plenty of space for all kinds of activities." But when you look around in Evansville, you don't see much physical activity going on, except in the evening along the banks of the Ohio, where the homeless get drunk, and during the day at the main bus station, where a lot of very fat people sit in the waiting room drinking sugar-saturated drinks from cups the size of flower pots.
Shopping malls surround the city like the camps of a besieging army. The malls, connected by multiple-lane highways, are the focal points of public activity. The obesity epidemic is in full view at the large Eastland Mall on Green River Road, which has a floor plan in the shape of an elongated cathedral. Chunky parents walk around holding the hands of their bloated children, while shoppers in tightly fitting XXL T-shirts sit around on benches consuming generous portions of fried chicken, soft-serve ice cream and smoothies.
Wanting Change
Of course, all of this sounds like a tired cliché, a well-worn caricature of America. But, sadly, it is actually a snapshot of reality.
In Evansville, it feels almost unreal when Shirley Smith arrives in a taxi at the Walmart supercenter on North Burkhardt Road. She is 47, not very tall and weighs 350 lbs (159 kilograms). It takes a while before she's extracted herself from the car, and then, supporting herself with crutches, she gets into an electric wheelchair that's intended for people in frail health and is much too small for her. Folds of her soft flesh hang down from both sides of the seat, and she's perspiring heavily. She's suffering, a lot, she says.
She says she has diabetes, high blood pressure, poor liver function, water in her shapeless, swollen legs, trouble sleeping and digestive problems. She's also worried about cardiovascular disease and missing her incisors because she says she can't afford to visit a dentist. But she has lost weight, she adds, 15 kilograms in a year, and she now eats lots of fruit and vegetables "and all that other stuff." Then she rolls away at a walking pace into the aisles of Walmart, where the package sizes for ice cream and ham, soda and potato chips, cheese and popcorn erase any distinction between wholesale and retail.
Mayor Winnecke pauses for a moment when asked if he's ever thought about taking his awareness-raising campaign to shopping malls and fast-food chains. Perhaps he thinks the question is naïve. Perhaps he's asking himself what he, the mayor of a small Midwestern city, could do against major corporations. "I know perfectly well that they can't make their rolls big enough," he says, "and I don't understand why you have to drink soda out of buckets." But, in the end, he adds, everyone in America has to be able to decide for themselves what they do or don't want to eat or drink.
"That's not going to change," Winnecke says. But it sounds more like he's saying it can't change.
A Mayor's Crusade
But change is exactly what Americans have been arguing about since New York Mayor Bloomberg made headlines with his soda ban. The ban, which is expected to go into effect in September, is part of a 23-page "Task Force Plan" that seeks to "reverse" the obesity epidemic. It affects movie theaters, restaurants, delicatessens, food vendors and fast-food chains of every stripe. Bloomberg wants to prohibit them from selling beverages in cups larger than 16 ounces, which is about half a liter. As mundane and ineffective as it sounds, the move is actually a revolution and a rejection of the quintessentially American "bigger is better" culture.
Of course, many only see it as a threat to freedom. Can McDonald's and Burger King be prohibited from selling soda in giant cups? And what about America's other, less well-known fast-food chains? At White Castle, for example, a 21-oz. (0.6-liter) beverage is still considered "small," while a large beverage is 44 oz. (1.25 liters) and iced tea, usually sweetened, is sold in cups that hold up to a gallon, or 3.8 liters. Kentucky Fried Chicken sells soda in 65-oz. "Mega Jugs," each containing 210 grams of sugar and almost 800 calories. At the AMC Empire movie theater on Manhattan's West 42nd Street, the smallest drink size is 32 oz., or twice as big as the limit Bloomberg wants to impose.
To justify the ban, City Hall is quoting thousands of studies and rattling off frightening statistics. For example, obesity costs the United States $200 billion a year in hospital and doctor costs. Every year, 5,800 New Yorkers die of the consequences of obesity, and 700,000 are diabetic. According to the mayor's office, "sugary beverages" are the most important cause of the crisis, and the aim of the ban is to force consumers to think about their consumption habits.
It isn't Bloomberg's first coup. The multibillionaire has already imposed extensive smoking bans on his 8.2 million fellow New Yorkers and used taxes to drive up the price of a pack of cigarettes to $13 (€10.5). In 2005, he banned the use of harmful artificial trans fats in food and, in 2008, he forced all restaurants in the city to list calorie counts on their menus. In 2010, Bloomberg saw to it that welfare recipients could no longer use food stamps to buy soda, but he failed in an effort to impose a soda tax that would have been pegged to drink sizes.
Bloomberg's messages, including warnings about drinking too much soda, and his appeals to live a healthier life are all over the city's subway system. The mayor makes such a fuss about health issues that cartoonists at the New Yorker can hardly keep up. On one of the magazine's covers, Bloomberg is depicted as a narcissistic dandy staring adoringly into the mirror, and soon he'll undoubtedly be caricatured as a health tyrant.
But even if vanity is his driving force, it would be very hard to find another politician who is staging such a large-scale, frontal assault against the interests of multiple major industries and their suppliers.
Fierce Resistance
In this sense, what Bloomberg is doing is courageous to the point of foolhardiness. But is it the right thing to do?
The results of his crusade are mixed, and the relevant studies are frustratingly inconclusive. Despite calorie counts on menus, people still eat too much in New York -- and sometimes even more than before. Smoking bans haven't stopped people from lighting up. And welfare recipients still find ways to get their Cokes and Pepsis.
In generally poor areas, such as the Bronx, and in neighborhoods with large Hispanic and African-American populations, obesity is spreading like a disease, one that's already infected more than 70 percent of adults in those parts of the city. They are also the neighborhoods in which Bloomberg's activism runs up against the most resistance. If reader comments in newspapers and informal street polls on television are any indication, a majority of the affluent, slim white population favors the city's health-related policies, while a clear majority of overweight members of the lower classes see them as an assault on American values and personal freedom. When push comes to shove, the latter are the true philosophers, because they ask: What would freedom be worth if it didn't include the freedom to destroy your own life?
Bloomberg, ever the pragmatist, says that he doesn't want to prohibit anyone from drinking sugary soft drinks. But he also points out that science shows that smaller portions generally lead to reduced consumption. Referring to supersized beverages, Bloomberg said: "It's not something that the Founding Fathers fought for" -- and yet it's exactly what the beverage industry, movie theaters and fast-food chains are promoting with abandon. They want to sell more -- and not less -- Sprite, Fanta, Coke, Pepsi, Dr. Pepper and Mountain Dew. And they're worried that Bloomberg's latest foray could be emulated elsewhere in the country, even in the form of statewide laws in some states.
In New York, after a brief period of shock, industry lobbyists have come to life once again. On weekends, small propeller planes pulling banners with the words "No Drinks 4 U" can now be seen in the blue skies above the amusement park at Coney Island, in southern Brooklyn. There is now an initiative called New Yorkers for Beverage Choices. Likewise, shortly after Bloomberg's announcement, a full-page ad appeared on page 3 of the New York Times that depicted the mayor as a fat nanny and warned against the "nanny state," criticizing Bloomberg for being paternalistic and patronizing.
In other parts of the country, the fuss in New York still feels like something making noise a far way off. In Atlanta, where the Coca-Cola Company is headquartered, the company's own theme park is as busy as ever. Chubby Americans squeeze past each other at the World of Coca-Cola at Pemberton Place, where they can admire the beauty of a global brand, a bottle or a logo without having to think much about calories.
Nowadays, it seems quaint that the first bottle of Coca-Cola contained only 6.5 oz., or less than 0.2 liters. Old advertising posters in Coca Cola's Atlanta Museum depict the half-liter bottle, a novelty at the time, as being perfect "for serving three." Those days are long gone.
The Battle Lines
Today Lacy McNear is talking to schoolchildren in Evansville, Indiana, who rehydrate over the course of the day with three or four half-liter bottles of soft drinks, to children who no longer fit in their chairs. McNear is 28, very friendly and very blonde, slim and dedicated. As a nutrition educator at St. Mary's Hospital, she gives talks in the city's 30 schools to "raise awareness." She has a positive outlook. "Seatbelts, recycling, smoking; they were all difficult campaigns, but they were all successful," she says. "If we can reach children, we achieve a great deal."
Her office is filled with boxes and even roll-away suitcases of visual aids that look like gag gifts. There are small and large spaghetti portions made of rubber, and plastic pieces of imitation muscle and fat tissue. There are soft cases of test tubes filled with the amount of sugar in a soft drink, a donut and a chocolate bar. McNear has a plastic model of a child's stomach, which she uses to illustrate how small it actually is. She has 25-pound "fat vests" that schoolchildren can put on to get an idea of what it feels like to be fat. At the end of each lesson, she instructs them to go home and tell their parents what she's told them. Doesn't anyone complain? "On the contrary," says McNear. "I got a letter from a grandmother who told me that, thanks to my class, her grandson ate a salad for the first time in his life."
If McNear inspires confidence in her air-conditioned office at St. Mary's Hospital, lunch at the Gerst Bavarian Haus restaurant is a brutal reminder of everyday life in the Midwest. Deer antlers decorate the walls under the high ceilings of a former iron-goods store, the beer of the month is Weltenburger Kloster, and the "sausage sampler" appetizer alone has an estimated 1,500 calories, 900 of them from fat.
The diners are a collection of local heavyweights, a reflection of the region's history of German immigration. Oktoberfest is practically a daily occurrence at the Gerst Haus, which serves too much of everything at prices that are too low: sausage, schnitzel, potato salad and beer, or what Americans call "comfort food," although it makes people sick when consumed in excess.
'What Customers Want'
Is there some sort of strategy in this so-called war on obesity? Is there government coordination? Are there national crisis plans? If there are, Mayor Winnecke hasn't been told. Of course, he says, that could be because he's only been in office for six months.
Sometimes he sees First Lady Michelle Obama on the "Today Show." She has made healthier living in America her biggest cause, and sometimes she even jumps rope in front of the cameras to make her point. There are various White House task forces on the issue, there are federal laws regulating the kind of food served at school cafeterias, and there are "National Soda Summits" at which local health advocates talk about their campaigns and experiences. On the whole, an enormous amount of paper is being produced on the subject -- in universities, federal government agencies, city councils and state governments. Countless speeches are given, and millions upon millions of calories are burned at sporting events nationwide to support the cause of healthy eating.
But it is possible that all of these efforts are in vain, considering that the industry lacks good intentions and, in fact, is dedicated to the cold and single-minded pursuit of one overriding purpose: to generate profits. "Oh no!" says Lacy McNear, the nutrition educator, when she reads what USA Today, one of America's largest daily newspapers, has just reported on its front page that three large, nationwide chains -- Taco Bell, Steak 'n Shake and Sonic -- plan to market sugary soft drinks more aggressively as part of their breakfast meals. They do it, quite simply, because soft drinks are more profitable than coffee -- and, of course, as a Taco Bell spokesman says, it's "what customers want."
But has any customer every really wanted Steak 'n Shake to sell 28-oz. Coca-Colas at a special price of $1.79 for breakfast, between 6 and 11 a.m.? Just under a liter of cola for a little more than a euro?
The answer is probably yes. Many Americans drink anything that fits into the cup holders of their cars at all times of the day. "It can't be true," says nutritionist McNear. But it is. People are now drinking supersized soft drinks for breakfast, and the portions are just as big as they are at other times of the day. The 7-Eleven chain got rid of its giant Double Gulp drink size, not because of health concerns, but simply because it wouldn't fit into cup holders in cars.
Nowadays industries are only forced to react when they perceive a threat to their image, or what insiders call "reputation risk." McDonald's removed supersized cups from its menu years ago in the wake of the scathing 2004 documentary "Super Size Me" and then went on to market itself as a health-conscious brand. Coca-Cola is making more and more noise about wanting to be "part of the solution," introducing more low-calorie and no-calorie beverages. The company's sales of full-sugar drinks have declined considerably in the last 10 years. But even with these changes, the industry cheerfully continues to spend billions to market sweet drinks to young customers -- and many billions more than the government spends on health education.
When Evansville Mayor Winnecke attended his first mayors' conference recently, the obesity epidemic wasn't on the agenda. A fellow mayor from Kentucky said a few words of praise for his efforts to raise awareness and address the problem in the first place, and Winnecke appreciated the recognition. His isn't an easy task. Fighting obesity is a sensitive issue, and it doesn't win votes, at least not in Evansville, Indiana.
The city is known for fried cow's brain sandwiches, baked chicken and a street festival in early October during which 125 food vendors line up along Franklin Street. It's supposedly the second-largest street food festival in the United States, next to Mardi Gras, in New Orleans. Vendors sell kangaroo sandwiches, bacon brownies, corndogs and deep-fried candy bars. Here, in mid-America, it feels like there's no tomorrow.
