CAROL PARKER-DUNCANSON: I'm Carol Parker-Duncanson, and as [? Blaine ?] said, I am the leader for our Nutrition and Health Program in New York City that works with low income families. So we have been doing this over 40 years, doing nutrition education in the communities, in many of the low income neighborhoods in New York City.
So I am a practitioner of nutrition education, primarily community nutrition education. And I'm affiliated to the university through the Cooperative Extension System. So of course, that system-- as I have on the slide-- we have a public mission as a part of the land grant university system. And that is to provide education and outreach and applied research, which is what we do, touching every aspect of life in New York. So that's what applies totally for total land grant system.
And so the research-- the word "research"-- is always a part of how we state our function. And so I need to point that out because we have-- of course, I have two of our prime researchers with us here on the panel. And the component of the work that I do is the outreach part, translating that research knowledge into what people can do. OK.
In New York City, again, we repeat the mission statement. Our mission statement in New York City, advancing New York City through research. And this is what we do. Now, I thought that as a part of my presentation, I wanted for you to kind of have a little immersion experience, similar to how I actually-- how we do what we do in the work that we're doing. Because we're teaching families about nutrition, and we're talking with them. And we have a very visual hands-on type of experience, where people leave our education environment with knowledge and behavior changes that are so important, relative to what they do.
So I just wanted to ask you, because you're all here, because there's obviously an interest in this particular topic. And if I threw a question out to you, like for instance, if you had to come up with maybe the top two issues or the top two things that you would identify as being two of the major factors that are associated with this obesity epidemic that we have in this country, what would you say that they were? And I'm actually asking the question.
AUDIENCE: Probably that a lot of times food that's not that nutritional is cheaper.
CAROL PARKER-DUNCANSON: OK, cheap, unhealthy foods. OK. Good. Anybody else? Any other ideas? Any thoughts? I mean-- yeah.
AUDIENCE: Lack of exercise.
CAROL PARKER-DUNCANSON: Lack of exercise. OK, that's a good one. Anything else? Anybody would say, well, you know, what I know for sure according to Oprah?
AUDIENCE: Probably a lot of body images are too thin. I think women need to have some [INAUDIBLE] personal trainer. It's one of the things I do. And maybe some people think, I'm never going to be that skinny. So whatever. So there's no balance. You need balance.
CAROL PARKER-DUNCANSON: OK, they give up. You know, whatever. I'm just going to do what it is. I'm never, ever going to look like a Twiggy or a Tyra or somebody of that nature. So usually, when we work with low income families and we ask that question, many of them come up with some of the things that they say, that you say. But a lot of them talk about yes, we also have too many fast food restaurants in our neighborhood. My kids are watching too much TV.
And they talk about candy and soda and stress and all kinds of different things. So this is a popular way that we do to sort of engage people, have them to start thinking. Because it's so important to get their idea about what they think before we start to impart our research-based knowledge. And we respect their knowledge and their experience in terms of interacting with them and motivating them to change their behavior.
Now, what we do in our program in delivering nutrition and health, we deliver it in a manner that is focused on utilizing what we call indigenous frontline educators. And that's important for you to understand because when we work in low income families, the educators that we hire are the people from the community. We train them in some nutrition content-- a significant amount of nutrition content-- and then we send them back to teach their neighbors and their friends and their children.
And they're the most effective means that we have found to research in terms of delivering comprehensive nutrition education with long term behavior change. So this is our educator working. We're using our USDA approved material, education materials. And we're involving them in a lot of different types of activities. So this is what our personal goal is. Fun, of course, is a word that's interactive. And definitely with a personal touch.
So we include families, oftentimes with young children. That's our major target audience. We build in physical activity experiences for them, and food is a big piece of it in terms of what we do. Here we are, whatever, engaging in physical activity. We do a lot of work with youth in classroom settings, after school, summer youth vacation Bible school.
We do all of that kind of stuff. A lot of work with seniors and the elderly, food shelters, shelters, homeless programs, pantries and soup kitchens. A lot of that work. And a part of it also is we do group supermarket tours. Because we want to talk about the marketplace. When you're in the store, how are you going to be making choices? So we are oftentimes involved in doing some of those.
And our participants all receive a certificate of completion after they've done our series, which actually is a requirement, certainly if they want to work with us. So many of our recipients we hire to come and become our employers. Here we are outside in the field in farmer's market, health fairs, and other kinds of things, doing a lot of this kind of work.
So I wanted to see an image of that, only because it gives you a visual perspective of the work that we do and how we are doing it. Our focus is on behavior change. The elements primarily are diet quality, food safety, feeding children, food resource management, how to stretch the food dollar, a major component of what we do. And so the task of taking the research and making it evidence-based-- taking the evidence-based research and making it practical-- is where our expertise comes in in working with families.
And we do this by taking the recommendations that are made and converting it into the how do I do this. And that is what we have found to be the way that we have had the greatest impact. We use visuals and hands on, as you can see from the picture. And we also have an evaluation component. We're a research organization. We just can't do programming and not have a evaluation component.
So we have a preassessment of behavior, and also of dietary intake. And we have a post assessment after we've had a six to eight week intervention. And from that data, we've been able to see the outcomes and the impacts that we've had on intake, certainly and on behavioral practices. So this is a built-in component. And it's something that I said, we've been doing it for years.
Our funding comes from the US Department of Agriculture. So with that funding, of course, primarily through our SNAP Ed program. Many of you have heard of that before. But also our Expanded Food and Nutrition Education Program, the acronym EFNEP. These are the programs that our funding sources come, and a part of that funding source requires that certainly we use the USDA research material that are developed and made available for the public as a part of our teaching resource.
So I would say that our bible probably from which we get our information in terms of teaching would be the Dietary Guidelines for Americans. And we of course use other materials, like the Choose My Plate information, things from Team Nutrition, and other kinds of publications. Those are the materials that we use to teach. So as I was preparing for this presentation, I certainly went through reading umteen research articles, went literature, looking at-- I just came from a Society of Nutrition Education conference in Washington DC. So of course, there's a lot of that, talk to a lot of different people. And then I also decided that I was going to do some underground research myself.
So I was in Washington DC, and we were staying in the Shoreham area, which is near Adams Morgan, a hotel there. And I decided, I just want to be a fly on the wall, just walking into-- they don't have bodegas or corner store in that area of Washington DC. So the closest place to get some beverages in a bottle setting would be the CVS. There's a big CVS on the corner.
And I said, let me just go in and see what the environment is like. We were going through a heatwave. It was like 98 or whatever, close to 100 degrees on Monday and Tuesday. So I went in, and I said, well let me take a look at their refrigerated beverage section. And I counted each panel. There were like 14 panels of beverages.
And in that 14 panels of beverages, there were actually three with water and eight with what we would consider to be sweetened beverages, including Gatorade, Vitamin Water, the soda things. There were eight of those. And I could not-- the smallest size was a 20 ounce bottle. I was hoping to probably see a 10 ounce can.
And then I was thinking, wait a second. You know, I haven't seen 10 ounce cans in these showcases in a long time. But we have 20 ounces all the way to 32 ounces. So I looked, and I got to the panel. I checked, and I said well, if I walk into the store, the first three panels I would see were sweet and soda beverages, OK. But then there was a panel of water. Then I walked, and I walked five more, with increasing sizes, incrementally increasing sizes. I noticed because I had to put my glasses on to see. There was a 23 ounce can, and I went to 28, and then I went to a 32 ounce Gatorade.
And then there were two panels of water on the end. So I said, well, hung around a little bit. Let me see what people are doing. Folks came in. It's nice and hot out. The bus stop is right there. The metro was right there. Folks came in. They grabbed-- they're going to the sugar thing, and they grabbed-- and some folks grabbed water or whatever.
And I was just thinking, because I was with Brian [? Wansink ?] a couple of days earlier. And I'm thinking, mindless. It came to my mind. I said, wait a second. Mindless drinking. Because I know that the people that I observed-- it was about 15, 20 people at the time-- I don't think any of them thought about what they were doing. They just opened the glass, and they reached in, took something out, and of course it was put in a bag. And the thing about it, that beverage is for one person. There was nobody buying something getting an extra cup or thinking that they were going to get two straws to share it. They were going to be using it only for themselves.
So I came back to New York City, and I spent some time in the South Bronx. The mayor was-- there was a big release of sharp health in New York City thing, in the Bronx yesterday. So I went into a Bronx bodega. I was able to find one in the area of the Bronx that I was. Went to the bodega.
I did sort of the same estimation of the-- whatever. And I saw that the showcase panels for sweetened beverages was at least three or four times what it had for what I would consider healthier beverage choices. And for them, the healthier beverage choice would have been water.
I also went to the 7-Eleven around the corner on 34th Street. And I had a wonderful surprise this morning. I walked in there, and on the 7-Eleven, there were like four or five panels with sweetened beverages. At eye level, there was an 8 ounce bottle of Pepsi, Diet Pepsi, that was in there. One shelf. OK. And there was one panel with 10 ounce sodas. But everything else was 20 ounces or more.
So I said, wow. I looked at the bottle of the-- I recognized it from the past, the new bottle of the 8 ounce Pepsi. And many of you are here look quite younger than I am, but many of you might not remember that there was a time when women wanted to have a Coca-Cola bottle shape. It was actually what women wanted. It looked like the new 8 ounce Coca Cola bottle. And I was having that image of that 8 ounce Coca-Cola bottle shape that we desired when I was young, to what the shape now is of our new 20 and larger bottles.
But I will say, I found it, 8 ounces, on one shelf. And I said, wow. That's a choice that people have in that particular situation, if they wanted to make it. It wasn't a lot, but at least it was there. So people could actually make the choice.
So the reason why I'm saying all of this is because our dietary guidelines-- literally, we call it our bible from which we get our information-- they have two basic recommendations around-- two basic recommendations. That's the premise of the dietary guidelines. The first one is maintaining calorie balance over time to achieve and sustain healthy weight. OK. And the second one is to focus on consuming nutrient dense foods and beverages.
So how do we help our participants in a climate that we have right now to follow that particular recommendation, certainly as it relates to consuming sweetened beverages? We teach them about portions, how much. How much are they eating? We use props like this to relate to people that the social norm of sizes right now is very different from it was 30, 40 years ago. Our average plate size has moved from a 9 inch to 10 and 3/4 inches sometimes, or if could go up to 12 or 10. I don't know if any of you have eaten at-- what is the name of that Italian food restaurant?
AUDIENCE: Olive Garden?
CAROL PARKER-DUNCANSON: Olive Garden. You know, they serve you in a platter. So it's not even a plate anymore. It's a platter. I brought these things from home because I wanted to share with you the fact that in my home too, we have an issue with portion size, as much as we try to do things.
And so the average cup, we have people who love this cup here. Our bowls have moved now to-- I measured this this morning-- 22 ounce bowl. OK, this is what my children are drinking cereal out of. So their norm is not the norm of 20 and 30 years ago. I was saying-- I was telling someone-- I was telling you that I was looking for a teacup.
Do you know-- anybody remember the 8 ounce teacup that came in a saucer? If you look at silverware, I mean, diningware right now, they don't have those sets anymore, except if you're buying this wonderful china whatever for a wedding present or whatever. But your everyday stuff is not those. These are your everyday things. And I have this because this is the smallest drinking glass that I have at home. And this is a typical one that my children are drinking out of, everything. OK.
I remember that there was a time when I grew up when our cup sizes looked more like that. But they're not that anymore. You know, it's a society that we're living in right now when a small coffee is called grande or tall, whatever. So you know that we are at the point where our social norm in terms of portion size have totally shifted.
So we bring these things for participants, and we show them. And we know that these are some of the things that they have at home. Some of them bring serving bowls, and they say, well, we're eating out of one of those things that they have in the back. That's what my kids are eating out of. So we're going to now take them from how to shift from this to making healthier choices.
So we talk about portions. How to reduce intake of sweetened beverages. Don't even buy it. Do not bring it in the home. Start right there. Don't put it on the table and serve it as a meal. You don't sit with soda and then insist that your children drink milk or whatever. Just avoid it. So we give them that kind of information in terms of that.
But our major concern with this is because the intake of those sweetened beverages, it's displacing the healthier choices, which would be maybe 100% juice in some instances, low fat milk and dairy, and certainly the ultimate thirst quencher, which is water. So when we talk about reducing portion sizes, we include those kinds of messages. The other issue that we teach, which is just practical about what we can do within the home, is to be mindful of the environment.
Many of our families are saying, well, you know, there's-- but they don't have to tell me, because I go in the neighborhood, I work in it, and I go through it. There's a Chinese food store on every block. There are bodegas on every corner. When you go in, you see the options that they have in their face. It's in their face, in the present. And how that prompts their choices oftentimes.
And it becomes like mindless choosing or mindless decision making sometimes, that you're just doing things only because. So we talk with them about the access. And this particular concept of environmental factors that might affect their choices, it's not an easy thing to teach. Because people are just not aware. Many of our family are so bogged down with other kinds of things that they're just not thinking. They know they don't have, and they probably just accept it. And so this is what we're finding.
And it's everywhere. It's where we live, where we work, and where we play. When you go to a playground, and the soda vending machine-- I mean, the vending machine is some kind of sweetened beverage-- those are the things that you choose, as opposed to if you only had water. So no matter how much we teach folks about their environment, the thing is that we can't move them out of their environment. They're there. They live it. So the battle for us is giving them nutrition behaviors, and having them become aware of it, and still helping them and asking them to make choices.
So the changes in the environment as it relates to the marketplace is a big issue for us. And you know, I really want to-- in terms of my feelings about this particular policy change-- is the fact that the responsibility to change the environment, I find it's a collective responsibility. We often say it's an individual, but I think actually it's a collective responsibility. And it requires a collective response.
So I feel that if it's recognized as being important, and it's expected-- that recognition and expectation is at all levels, which include policy levels, prevention levels, health care levels, education levels, and in the marketplace, that I would-- in our position as community nutrition and education-- I would support policies-- let me say that-- that are aligned with our goals of using evidence-based information to inform our teaching. And the message that we teach and from the research that I know, that I've read and I'm aware of and I'm conscious of, is that increase portion, increase consumption.
And so in thinking about our social norm and the shift that we have right now, we don't know for sure whether implementing this policy is going to work. And most likely it can, in some way, in its intent to reduce access and availability. And maybe it will help in shifting our social norm again. Maybe. We don't know for sure.
But the bottom line, which is a term that is often used in the marketplace, is that our families aren't even talking about it. In the communities that I work, there's nobody talking about the soda ban. There's no discussion. It's not a thing that people and families are worried about. It's not a major part of their thought process at this stage.
So my perception is that they're faced with so many other major issues right now to deal with, that they're probably depending on institutions and/or government to make decisions and implement policies that will benefit them in the long run. And that's my perception, that they're actually depending on a collective response, and for the institutions and the government who they trust most of the time to come up with decisions and make some policies that will be effective them in the long run. So that's my statement.
LOUIS J. ARONNE: Thank you very much. Thank you. That was [INAUDIBLE]. Do you call this a single serving of soda? Or-- I was yelling at Blaine, because he doesn't have a bottle of soda for everybody. Aren't you all upset that you didn't get one of these? We'll come back to that later.
But the soda ban. Consumers deserve freedom to choose. This is something you've heard, right? There's no question that they do. But they deserve freedom to choose small portions if they want that, is my point of view. They are being held captive-- I believe that they are being held captive by the companies that are selling the portion sizes. They're setting portion sizes.
And that it may put consumers-- particularly adolescents and teenagers-- in a situation that is very unhealthy. And it's a situation that is obesogenic. And I'm going to show you the evidence that obesity, once it begins, may be very difficult to return from. So it's sort of-- one of the things we've recognized is it's kind of a one way pass, one way ticket, on the road to bad health.
And what is it with the obesity epidemic? Why does this keep happening, and why don't people who are obese just get with it and lose weight? Now, this is the obesity epidemic. This is from the National Health Nutrition and Exercise Survey, 1960-62 to 2007. Overweight stable, obesity increasing dramatically, and extreme obesity going from 0.9% to 6%. So the biggest increase-- so now 73.9%, 74% of the population, three out of four people are obese. And the increase has come in obesity, body mass index greater than 30. Overweight has been stable.
That is a little bit unusual. It's not that everybody's gained a pound or two. It's at this end of the spectrum. And if we dissect it even further-- if we looked at BMI greater than 30, BMI greater than 40, BMI greater than 50, we see that there's almost an acceleration, an acceleration in the increase in these BMI categories. So that the biggest increase is in the highest BMI range.
And I would argue that that suggests that there is a physiology behind this. It's not that everybody's eating 100 more calories a day. It's that something physical is pushing people once they get to a certain threshold. They get to a certain point, and they're being pushed higher and higher. This is the increase over the past five years. BMI greater than 30 increased 24%, greater than 40 was 52%, greater than 50 was 75%.
And these are very, very worrisome trends. These are the people who cost a lot of money in the health care system. I'm not here to talk about that. But these are the people who cost us thousands, millions, and billions of dollars in the health care system, and the increased risk of complications.
Now let's look at football players, the healthy specimens of the NFL. For the past 30 years, football linemen are 68 pounds heavier. This is the mean weight of linemen on the winning team in the Super Bowl. It's from the New York Times. And then I looked at the team that won in 2011. It was the Green Bay Packers. Their offensive linemen were 316.3 pounds. Back in 1972, 248.2 pounds.
What is going on that keeps pushing weight higher and higher? How do you do this? And the biggest concern we have is among adolescents, teenagers, children. Right now 34% of adolescents and the 12- to 19-year-olds are overweight or obese. The most prevalent cardiovascular disease risk factors are there in the overweight and obese.
The rate of diabetes and pre-diabetes rose dramatically from 9% a few years ago in 1999 to 2000, to 23%. 49% of overweight and 61% of obese adolescents have more than one risk factor. But here's the thing I want to point out. That in June, we diagnosed four 18 and 19-year-olds with diabetes and pre-diabetes. Four in one month.
We have never-- we'll have one here, one there. There are months where we have none. In June-- which is when we see more teenagers because school is over-- we saw four of them. Four of them. And they cut across socioeconomic path, all across, from high to low. And to me, this is more than the tip of the iceberg.
This is very, very worrisome, because it tells us that teenagers are not going to be protected from the diseases of obesity. It looks to me like they're developing these problems earlier, earlier than adults, where adults percolate along for decades. We're saying it's like an entire lifetime of illness compressed in 10 years.
These are typically teenagers who started gaining weight when they were 9, 10 years old. And then they gain a tremendous amount of weight in early adolescence. And by the time they're 19, they have adult type diabetes. And interestingly, many of them, we see that their parents had it-- developed diabetes when they were in their 40s or 50s. Their grandparents developed in their 60s or 70s.
This is a very typical pattern. And this is why we're so concerned. There are now more than 60 diseases associated with obesity, more than 60. And in the past, we used to say, gee, how does being overweight and obese cause disease? That can't really happen, but now it is crystal clear that the hormones that come from fat cells, combined with inflammation that is caused by excess fat in and around the abdomen and other parts of the body, triggers the diseases that we associate with obesity.
And the reason it's so powerful as a disease causing entity is that there are multiple hormones. There are many different hormones that all occur at the same time. So for something like breast cancer, for example, you have growth factors, estrogen, inflammatory hormones, all of which promote breast cancer. So what happens? You have a tremendous increase in the risk of developing breast cancer in obese women. And that is not going to change. It's getting, again, earlier, earlier, and earlier in generations.
The big ones-- diabetes, coronary heart disease. Recently, people have been saying, gee, wow. It's great we're treating coronary disease. People are doing better than ever. What we aren't saying is that they're developing coronary disease at an earlier age. So one of the reasons that people are doing better is that now they're physiologically younger than they used to be. So instead of being 70 years old, now you've got 35-year-olds developing coronary disease. And so they do better when they go for a bypass. These are some of the statistics that get lost in the data.
Now, I wanted to point out this paper, which to me makes a really important point. And this is by three very-- by a number, but three primary groups of researchers from around the country. Obesity is associated with hypothalamic injury in rodents and humans. Obesity associated with hypothalamic injury. That is damage to the brain.
Not going to go into this in detail. But basically, what this lays out is an incredible series of experiments that show that feeding animals fattening food-- food that causes them to become obese-- overloads hypothalamus neurons. And as a result, when these neurons are overloaded, it's almost like a transformer, an electrical transformer, being overloaded with electricity. It can blow out.
And when that happens, eventually there may be fewer and fewer neurons to handle the signaling load, the load of signals coming from the fat cells, from the intestine, from other parts of the body, which tell the brain how much fat is stored. So what do the higher centers of the brain do to keep the signaling the same? They try to expand fat mass and increase the amount of food that's coming in. That is the wisdom of the brain. The brain says, OK. Let's amplify the signal.
But what this seems to lead us to is the ratcheting phenomenon, the thing that is causing weight to go up, up, up, and not be able to go back. And again, that's not the topic of the discussion. But the point is, this points to the direction of the interface of the environment and something physical that's going on, something physical that changes in the body that makes obesity inexorably move up, up, up, and never want to move back. OK. And again, I'd be happy to answer questions about it.
But this is a hypothetical model we've put together, very simple. High fat, high carbohydrate foods causing this hypothalamic injury. They identify a very specific neuron called POMC neurons that are injured. There's not as good remodeling in animals with a tendency to obesity. As a result, the brain seems to not be able to tell how much fat is stored.
There's more fat mass to restore the equilibrium so the cerebral cortex and other centers can feel the way they're supposed to feel. There's a reduced sense of fullness and an increase in cravings. That increases food intake. There is a fat mass gain that actually increases hypothalamus injuries, right? How do you equilibrate the system? You take in more food. That increases hypothalamic injury by putting more strain on the neurons. And boom, you're back where you started from.
And we actually see this clinically, where people go through this very aggressive phase of weight gain. They almost don't know what's happening. They start gaining weight, and they just started gaining, gaining, gaining. And we've gone back now and looked at some of our patients who we followed for 15, 20 years. And we see that there's this brief period of time before we started aggressively managing them where they may have gained 30, 40, 50, 100, 200 pounds. And then we started treating them medically or surgically. And that was what stopped it.
So it brings up the question of whether or not things like this-- I mean, this was a long time ago, back in the '50s. Should we start Cola earlier? When I was a resident, the hospital I worked at, there were ashtrays in the auditorium. The hospital was built in 1955. Doctors would always be smoking. That was normal.
When I took in the 1970s-- taking pathology, a lung pathologist was a smoker. It's like, how does someone who's a head of long pathology at a major medical center-- it's at Hopkins. The guys would smoke cigarettes. He'd have to go outside, and he'd be back like a half hour later, and he smelled like smoke. And you're talking about lung pathology.
But in any case, when it came to soda, we wonder about these things. And so I got these off the internet. Look at that. Kids smoking cigarettes, and it could be that we will look at images like this, just a kid drinking soda. But it's a lot of soda. And that may turn out to be shocking, the same way that a child drinking, smoking a cigarette, is sort of a shocking or startling image to us at some point in time.
I wanted to show you a couple of papers that support this point of view, that maybe regulating the size of soda in an effort to allow people to choose smaller portions is a good idea. Going to get into this in a second.
This is a study by Barbara [? Rowles ?] and colleagues from a university in Pennsylvania. Call it that. And then looked at 33 subjects, 18 women, 15 men. It's a crossover design. And what they did was give different portion sizes of soda or diet soda or water. And they did a variety of things, switching around the size and looking at how much they ate at a meal that was served afterwards.
The result was that increasing beverage portion size significantly increased the weight of the beverage consumed, regardless of the type of beverage served. So here's our conclusion. Serving a larger portion of beverage resulted in increased beverage consumption and increased energy intake from the beverage when a caloric beverage was served. That was the bottom line. This was a very carefully controlled study.
Another study by one of our colleagues-- Brian Wansink from upstate-- was really very, very clever. And this doesn't have to do with soda. It has to do with popcorn. And many of you have heard of this study. This is a famous stale popcorn study. But what they showed was that they gave people either popcorn that was fresh, or popcorn that was two weeks old. And they showed that when they gave them a bigger bucket of popcorn-- even when it was stale, old popcorn-- they ate more popcorn. Even if they didn't like it.
So their conclusion, even when foods are not palatable, large packages and containers can lead to overeating. And they suggest that a good idea is that maybe if they apply this to less preferred, healthful foods, such as raw vegetables, you can get people to eat more vegetables. Give them a giant vat of raw vegetables, eventually they'll start eating more vegetables.
So now-- Carol, you went into this-- what is small? What's medium, and what's large? OK, so here are some traditional ideas. Soda, 12 ounces, 20 ounces. Here's a 34 ounce bottle of soda. And this is 140 calories, 240 calories, and 400 calories. You should know that when the 20 ounce bottle first came out, it was a three portions. It was touted as three portions. There was enough for three servings.
But how's this for choice? So this is from the Kips Bay-- the AMC Kips Bay movie theater not far from here-- small, 32 ounces, 310 calories. Medium, 44 ounces, 426 calories. Large is 51 ounces. So how big is this? Ladies and gentlemen of the jury, how big is this? Let's see, let's see. What does this say?
LOUIS J. ARONNE: It's 30--
LOUIS J. ARONNE: 34 ounces. It's a liter. So it's like 33.5 ounces. OK. That's a small. So this is the size you're going to get. This is the smallest size you get when you go to certain public venues. And again, I'm not pointing this out, but if you go to any large venue, that's going to be the smallest size.
Here's a movie theater where they happen to have-- our local movie theater has-- here's drinks. Small, medium, and large. They post the size, portion size, and the price. And it's hard to read, but 0 to 640 calories in the small. That's 450. 0 to 880. I'll go into this another slide. You can see it better. And here a large, 0 to 1020.
Here's what it says. A small is up to 660 calories. That's pretty big. That's $4.50. Medium is up to 880 calories. That's $5. And large, 1020, that's $5.50. So there's $1 difference. And no, it's not twice the size, but it's 80% more. So there's a strong financial incentive to increase portion size.
Now, I'm not going to spend time talking about this. But there are many studies in animals showing that when you get in the range of sweetness of sugar-sweetened beverages-- whether it's juice or soda or any of these-- that animals will markedly increase their consumption of these things. And it's because it hits certain receptors or whatever. But it's not very hard to get them to consume it.
In fact, they'll consume 90% or more of their calories per day of sugar-sweetened beverages. They won't have anything else. Like they won't eat their normal mouse chow. They won't eat anything. They'll only drink the sugar-sweetened beverage. That's it.
So it's not hard to get animals to eat or consume sugar-sweetened beverages. But to then give an economic incentive to increase the amount I think makes it very, very difficult. So in conclusion, I think that the fact that the minimum size-- the minimum size at many movie theaters and other public venues-- go to Garden, places like that's, it's 32 ounces. That is really the issue here.
And that trying to give people the option, the option, the option, to choose a smaller portion, is critical. There's an economic incentive to buy even more. The portion size is too large for teenagers and adolescents. Send your teenager and tell him, this is the smallest size Coke you can get. This is the one you're going to get. Tell me he goes and gets $5 worth of soda like that, that a teenager is not going to drink the whole thing.
And if you're an adult, you could buy two, three, or four sodas. You can buy five sodas. You could buy all the soda they have there. That's fine. You have plenty of options. Plenty of options are available to expand it. But, in my opinion, there's no option to reduce the size. Right now, the way the situation is, we are encouraging passive overconsumption. So you can tell that I'm in strong support of the soda ban. Here you go.
SPEAKER: Thank you very much. David?
DAVID JUST: Sure. So just to give you an idea of who I am to begin with, I am a behavioral economist. I make my living doing behavioral studies, essentially field studies, where we go out and we run experiments on people in the real world to see how they respond to little things in the environment. And I'll mention here this research center that I lead, the Cornell Center for Behavioral Economics and Child Nutrition Programs.
It's a center that's been open for a couple of years. We get our funding primarily from USDA. It's co-directed with Brian Wansink, who was mentioned in both prior presentations. And we'll mention him again. And we've been looking at a lot of how kids can be led to make healthier choices on their own. And come back to that idea, because I think it's actually a really important idea of how we can get people to make healthier choices on their own without sort of kicking them or holding something over their head to force them to do it, and why that might be a good idea.
So let me start out. And we just talked about this study. So I'll go through it very quickly. If we look at the research behind this proposal-- this proposed ban on larger sodas-- they actually cited a lot of studies by Brian, and a lot of others as well, saying exactly that. That if we have larger portions, people tend to eat more. In the case of popcorn-- and in particular, in the case of stale popcorn-- you double the size of that container, and they end up eating about a third more. And that's a substantial number of calories, and why in the world people would do that with stale popcorn that was greasy and a week old, I don't know. But they do. OK.
And we see this over and over again. There are actually dozens of studies that say something similar. It's true when you're dishing ice cream. It's true if we're talking about larger or smaller plates. It's true of anything that we've been able to see. But-- and what's the but? The but is there are two important differences between these types of studies and what we're proposing here in New York City.
And those differences are actually very important. One of the major differences is that these are randomly selected individuals. We had people coming into a movie theater. And as you're coming in, you say, here, would you like some popcorn? And they took whatever popcorn we gave them. We have no idea when they were walking into the movie theater whether they were even thinking of buying popcorn or not. We just gave them popcorn.
And that's a very different scenario than I'm walking into the store to buy a 32 ounce drink, and I'm walking straight there. It's a very different notion of whether it's given to you, whether you had decided you wanted it or not, or whether it's something that you specifically went in to buy. One is goal oriented thinking. I'm going to get this. And the other is, wow, that's a surprise. That's great. Thank you. So very, very different thing.
And the other piece of this is that manipulation was surreptitious. In other words, when we've done plate studies and we've had smaller plates or larger plates, people didn't notice that we had given them smaller or larger plates. We didn't say, you know-- somebody who comes in and says, I'd like a large helping of this, and say, we'll give you the small instead. Instead, is just, we either gave them the large one or the small one.
And it was in a setting where they're not going to be inspecting it. They're not going to be thinking about it. It is outside of their mind. It is mindless. Those are two really, really big difference. In real life, it's only those who want more than 21 ounces that are ordering more than 21 ounces, so long as there are smaller portions available. If the smaller portions are available, they'll order the smaller portions if that's what they want.
And really, that's one of the big problems we face, is there is this lack of choice. [? Carol ?] called it-- it's said perhaps it's soda companies that are sort of dictating to us and pushing these things on us. Well, in truth, yes. When there are things out there, and they're certain sizes-- whatever sizes they may be-- when we see the size, it suggests a social norm. And we see this over and over again in our experiments. Whatever that social norm is, we tend to drink that amount, or we tend to eat that amount.
And if there are smaller social norms, we eat less. There are larger social norms, we're going to eat more. But that social norm makes a difference. And if we had smaller sizes available, it might make a big difference in what people drink. But we don't. We have a lot of very, very large items out there. Come back to this in a couple of minutes.
Secondly, like I said, people enter these establishments having some idea of what they want, rather than being selected randomly into it. We don't know whether it really is the case that these types of social norm effects work uniformly on those who wanted the larger size. That's just not what the research says. What the research says is, you come in and you adjust portion size, and on average, people are consuming less if you have smaller portions.
We don't know if that's the case for the people who are specifically targeting the larger sizes. And so we can't really say that. I've got to throw some caution out there, that maybe this is not as well tested as we would like to think. Let me continue.
We've actually seen a lot of policies like this that were designed to get people to eat less fail. And I want to qualify that there are several different reasons you might implement a policy like this. And for example, let's take the calorie postings in the fast food restaurants. Now, some people were really in favor of this because they thought, this is going to reduce how much people eat. They're going to see the massive number of calories in these foods, and they're going to stop eating this stuff.
And if that was the purpose of the calorie postings, it was an utter failure. Because we saw study after study after study looking at this and showing that calorie postings made no difference in how much people ate. In fact, one of the only prominent studies that actually found an effect, the effect was the exact opposite, that those who are dieting tend to eat more calories when we have the calorie postings.
And why does something like that happen? Well, it happens because of what economists like to talk about, endogeneity. The fact that there is this selection effect going on. If I am at a fast food restaurant and I'm on a diet, well, I've decided to go off my diet already. And those calorie postings suddenly mean something very different to me than what they would mean in a normal situation. Right?
Now, does that mean that we should nix all calorie postings? I don't think that's quite the case, because they do provide a lot of information. And I still do think people who know how to use that information and are looking specifically for it will probably be able to use it, and probably benefit from it. I do think it should be publicly available.
But we've got to be realistic about what it does. In the moment when people are tempted, when they are in that environment, that information is too complicated for them. What they want is food. What they think about is how it's going to taste and how it's going to make them feel full. Those are the things that are going to happen in the moment. OK.
It's exactly those people who want these larger sodas who are going to be the people who are the most resistant to this ban. OK. So if people were-- so long as they've been able to buy smaller amounts, those people who are buying smaller amounts aren't affected by this. And they're the people who are probably most in favor of it. And the people who desire the larger amounts, they're likely to try and work to find some way to overcome this ban.
And it's what we call this behavior is it's reactance. Psychologists talk about it as if reactance. It's any sort of rebellion to a threat against freedom. So a couple of examples I'll bring up from my own research. When we've-- in an experimental setting, we've manipulated prices on food to try and see how people responded. And most of the studies out there that try and look at the potential impacts of fat taxes and things like that, they use normal price variation to try and figure out exactly how people are going to respond.
Well, we thought there might actually be a difference between a change in price and a change in price that I say is a fat tax designed to get you to eat healthier, right? So we ran this experiment, and we tried to figure out-- if we just change price, how do people respond? And if we change the price by the same amount, and we say, here's a fat tax, what happens?
Well, as you might expect, prices go up, people eat less of something, or they buy less of something. But if you call it a fat tax, they don't reduce their consumption by nearly the same amount they would if you just raise prices on them. They're trying to fight against it. The fact that you're taxing me, that you're taking away my freedom, means I'm going to push back, and I'm going to eat more of this. All right.
So to a certain extent, any time we're going to throw out some sort of policy that works to restrict freedom, the individuals are going to put up some resistance that's going to erode its effectiveness to some extent. Now, that doesn't mean that it's going to be completely ineffective. It doesn't mean that people who like to drink huge sodas are now going to drink more of those huge sodas than they did before.
We've just got to be realistic that this is going to erode some of the effectiveness of a policy like this. One very useful example of reactance that I like to use very often comes from one of the schools where we were doing some research. It's a very, very simple, simple example. In this school, in order to meet the nutrition guidelines for school lunches, this school did not allow students to take any more than one packet of ketchup with their lunch.
You ever try to use one packet of ketchup to spread all over your whatever-- chicken nuggets and fries and whatever else they might have been serving at the time-- that's difficult. There's not a lot of it to go around. Now, the whole idea was to get kids to eat just a little bit healthier. But that's not the way the kids interpret it as. They saw this as egregious. Ketchup is never going to make me fat, they thought. This ketchup, I should be able to take two or three of these and cover these things. It's the other food that's really making the difference that's the problem.
And because they saw this as egregious, they rebelled. And they threw a protest. And this wasn't a very damaging protest, but it's illustrative nonetheless. Protest-- the seniors, on the day of graduation, at the ceremony, each senior as they're walking by shaking the hands of the principal, they had in their hand a packet of ketchup. Right?
Now, you might think, well this is rather innocuous. If this is all that we get out of this, that might not be such a bad thing, that all we get, a lot of packets of ketchup on graduation day. But think for a moment what they're doing. If they are that organized and that incensed to put together a protest, have we helped them form some new health habit? No, we haven't.
When those kids are going to McDonald's, they are not taking one packet of ketchup for whatever they've ordered. Instead they're grabbing handfuls and handfuls, and they're saying, free at last. And taking tons and tons of ketchup. They're doing exactly the opposite of what the policy was designed to do. Because it was in a very limited circumstance.
That's what I mean by eroding the effectiveness of a policy. We've got to worry a little bit about something like that. Now, that's the end of my slides. Let me talk a little bit about some other potential ideas.
The thing that worries me the most about this sort of ban is that it is not tested. We have not tried this out this way, and we don't know what it will do. This is, for all intents and purposes, much like the calorie postings. This is a full scale field experiment in the five boroughs, right? That's what it is. Because we haven't seen exactly what this is going to do and how it might affect people.
Now, there might be some other ways to do something very similar, and maybe even to be more effective. Now, I pointed out a lot of the problem is the small end, right? We don't have the small amount available. And because we don't have that small amount available-- we don't have the smaller serving sizes available-- then we know people in that normal range probably are drinking more without really thinking much about it. They don't have any reactance to having large sizes that are only there. It's sort of an asymmetric effect.
What do you think would happen if New York City just simply went to the soda companies and said, we'd really like you to have smaller sizes available, and if you do that, we won't implement this ban? Do you think that might have a bigger impact? Or what do you think might happen if simply, for example, started regulating what you could call these sizes? Whether you can call it a normal or a medium if it's something like this that is gigantic.
We've actually done a little bit of research along those lines. And believe it or not, you serve food, identical amounts of food. And if you call it a regular size, people eat almost all of it, about 95% of it. And you call that same serving size an extra large, and people will eat only about 75% of it. They'll reduce their calorie consumption simply by you manipulating what you call it.
Now, think about that. That's astounding, right? It's astounding. I can see the size. I feel how full I am. And it makes very little difference compared to whether I called it something large or small. It's, again, that social norming effect.
There's a principle in economics-- I don't like to speak too much economicese, but if I have to, I have to. There's a principle in economics. It's called the principle of targeting. Essentially says something like this. If we want to accomplish this goal, then our policy should be designed to achieve that goal directly.
And why do we do that? Well, this all comes out of welfare economics. It makes it so it's the least cost and least drag on everybody involved in that system. So if we want to reduce the number of calories people are consuming, we should be throwing a policy out there that's directed at reducing those calories, not just chopping it off at 21 ounces and larger for people.
Because when that happens, when we've just arbitrarily thrown in this policy, it creates costs for the consumers that we may not need to put in there and achieve the same goals. It creates costs also for the producers and the retailers that they may not otherwise be able to-- may otherwise be able to find more flexible ways to obtain the same thing.
When it comes down to it, the soda companies, they're selling bottles of liquid. And they care not whether there's sugar in it. In fact, they love selling bottled water. It's a very low cost to produce, and they get the same amount of money out of it. There are a whole bunch of alternatives that they could employ that might be able to preserve their standing and preserve the consumer choices and still achieve the goal that the mayor wants to obtain.
And I would think there could be some flexible ways to try and do that. Beyond that, I would love to see them actually do-- and maybe even fund-- some research about what their policies are going to do so that we know ahead of time, so it's not this full scale experiment. Because while we've seen some that have had the intended consequence, we've also seen a lot that have had completely unintended consequences.
For example, what happened in the LA school district? When they got rid of all of the less healthy food in the LA school district, participation in the school lunch program took a nosedive. And if they're not buying the school lunch, they're probably buying something else, and it's probably less healthy. We've got to worry about this. It's got to be something more than just, I think this will do the right thing, so let's put it out there. I really would urge caution in that respect. And I'll quit there.
SPEAKER 1: Thank you. Thank you very much, David. If all three panelists would join us, I'm going to put the microphone in the middle and open it up for some questions.
AUDIENCE: This question is for you, [INAUDIBLE]. You talked about reactance. One of the victories that Mayor Bloomberg likes to throw out in this discussion is the smoking ban, and there is a lot of evidence that smoking in New York has gone down. I know that soda-- drinking soda-- is not the same as smoking. But was there reactance there?
DAVID JUST: There was. There was reactance there. And it did-- I would think that it made the policy less effective than if you could have accomplished something in a different way, similar. The thing is, is reactance is just another cost you have to consider.
Sorry I think about things like an economist, but I do. This is a cost that we have to consider in putting in a policy like this. And determine whether there aren't other policies that can achieve the same thing without creating the same drag. So yeah, there were some people when the soda ban-- or excuse, the smoking ban went into effect that did everything they could to try and fight back at Mayor Bloomberg or whatever.
There were bars that tried to flout the law. There were individuals who decided to smoke more than they had before, at least slightly, in order to try and fight this. It may have created some cost. And we don't know exactly what that was. We don't have full evidence on that. But it created some cost that made this a little less effective.
AUDIENCE: But in the end, I mean, I think people agree that it has been effective.
DAVID JUST: Absolutely. Merely by, say, larger families who decide to share sodas. Or is this something that's primarily going to be borne by people who decide to work all day, and just buy one soda in the morning, or something like that? We don't know who's going to bear this cost. We don't know where that reactance is going to come from and how strong it's going to be, simply because we've never done the studies. Right? Nobody's ever looked at it.
SPEAKER 1: Any other questions?
AUDIENCE: Sure. [INAUDIBLE].
AUDIENCE: Do you think that-- I mean, the way that people behave, do you think that people are going buy two-- when they walk into the movie theater, do you think they're going to buy two sodas? Or do you think that they're going to consume less?
DAVID JUST: So with movie theater sizes that we saw on the screen, I don't think very many people are going to buy multiples.
DAVID JUST: It will be limited to 21. Well, the 21, I think you would, right? I think you'll see some people who go ahead and buy multiples at 21 ounces. I, again, don't know what percentage that is going to be. But I certainly think some people are going to end up buying multiples. And whether they do or not, if they feel like they've been restricted, they're going to be resentful of this in some way.
How big is that effect going to be? That's something that really does remain to be seen. And I guess the question I have is, what's the goal? Is the goal to reduce soda consumption, or is the goal to reduce obesity? Because if the goal is to reduce soda consumption, I think this will have some pretty good effect. I worry a little bit about whether this is going to actually impact obesity directly, at least the way it's targeted, just towards the high end.
And if it doesn't, what happens? Well, if it doesn't, this is going to become something that raises the ire of a lot of people. And at the same time, is not particularly effective. And then it becomes a hiss and a byword, if you will, right? Other policies that could be effective won't be tried at that point because look what happened. We don't want that to happen to us. That's the worry. That's why you really got to know whether something's going to be effective before you just throw it out there, at least in my mind.
SPEAKER 1: Go ahead, and then we'll get you.
AUDIENCE: [INAUDIBLE]. So as far as the ban, would you be in more favor of some other policy, like a cap [INAUDIBLE] nutrition, and it seems like this would only-- people would still drink a lot of soda. So would you be in more favor of something a tax or any other policy?
CAROL PARKER-DUNCANSON: The tax related to additional cost of the item is something that has been proposed and talked about before. And I'm not really sure about-- because I know the [INAUDIBLE] cigarette, when tax alone was applied, I don't think it had much of an effect on smoking.
But when the restrictions in terms of where to smoke or whatever, that certainly had an effect. So I'm not sure if the tax, which would then increase the cost, if it would be as effective, possibly as just not having access because that's primarily what this ban is, limiting access to these larger portions. So the tax piece I'm not as confident about whether that would be as effective.
LOUIS J. ARONNE: I don't have much to--
AUDIENCE: Yeah, I had a question about the brain effects of obesity. Is that related at all to-- or does it cause-- because I understand that overeating can affect the same pleasure centers as other addictive drugs. So is this related to that, where there's death of cells that people don't get as much pleasure, or [INAUDIBLE]?
LOUIS J. ARONNE: Right. What I was talking about is not exactly what you're referring to, but there probably is some correlation. So you're talking about something that's slightly different, but all the evidence is that these things are sort of overlapping. And they all are going in the same direction, which is that by consuming food and larger portions of food, the systems fatigue, if you will, and want more food.
And then the regulating centers have difficulty sensing what the right amount of fat to have in a body is in those who are susceptible. I mean, interestingly-- and it looks like in animal studies-- there are animals who maintain a normal body weight. And no matter how much fattening food you give them, you can find animals who maintain a normal body weight.
Those animals seem-- even though those areas of the hypothalamus are injured, they get repaired. And so there's a lot of work going on now trying to figure out how do you repair these centers. But would that be good? Does that overcome the effect of eating quote, unquote, "fattening" foods? Those are very complex issues that are going to take years to sort out.
AUDIENCE: So the animals that would prefer to drink a sugar-sweetened beverage, so they stop eating their solid food, but do they not gain weight?
LOUIS J. ARONNE: Those animals do gain weight. They gain a significant amount of weight.
AUDIENCE: Because I remember some-- a while ago, people studying obese rats-- it's one thing to study a genetically obese rats. They're trying to get normal rats to gain weight. And they just found giving them Oreo cookies and Fritos [INAUDIBLE].
LOUIS J. ARONNE: You can give a number of different things to animals, and they'll gain weight. And then there are even mice where you give them-- they're very, very efficient. You give them normal mouse chow, and they become obese. So you have to pick the right models. I mean, I'm not a mouse doctor. I'm a human doctor.
But my colleagues tell me that you have to pick the right models. But generally, there are models where you can give fattening foods-- so saturated fats, you can give sugars-- and you see the same pattern of obesity. And they're remarkably similar to what goes on in humans.
AUDIENCE: So do you think that limiting consumption of soda will help obesity?
LOUIS J. ARONNE: Do I think-- it's not a treatment for obesity. And this is where there's been a tremendous amount of confusion in policy. So saying that, OK, we've removed soda from schools, and yet people didn't-- children didn't lose weight. That to me is not-- that's ominous. If I were a soda company, I would be worried by that because that says, uh oh. We did something that is not turning around. And that is not a good sign.
No, that supports this trend. So that is not a-- that's a prevention of further weight gain and preventing other children from not gaining weight. That's not treatment of obesity.
AUDIENCE: But it's a step in the direction towards the--
LOUIS J. ARONNE: Yes.
AUDIENCE: Overall epidemic.
LOUIS J. ARONNE: But I just wanted to be clear because I've seen a number of things quoted in the media saying that things like this will not work. Because when you take sugar-sweetened beverages out of an environment, we don't see weight loss. I would not expect that to happen.
AUDIENCE: Has the obesity epidemic leveled off? I saw recently some statistics [INAUDIBLE].
LOUIS J. ARONNE: For a given year, maybe it will. And we don't expect it to go up to 100% of the population. There's always going to be part of the population that's resistant. So I wouldn't expect it to just keep going up and up and up until every single person is, although some people have predicted that that will happen within 100 years, everybody will-- I don't think that's going to happen.
AUDIENCE: But has it leveled off?
LOUIS J. ARONNE: For a short period of time, it did. But then the most recent statistics show that it took another increase. So depends on the year. But again, when you look at the volume of-- when 3/4 of the population is obese, and when you look at the cost in billions of dollars-- and again, forget the obesity. It's the diabetes. And we're talking about things that have never been seen in the history of the world, like seeing some kids less than 20 years old developing adult diabetes.
To me that is-- it's like as a doctor, I was with our pediatric endocrinologist yesterday. And we're looking at this saying, this is unbelievable. This is unprecedented stuff. That is-- that's what's worrying us so much, and makes us realize that something really bad is going on. So if you're-- I'm not a public health official.
But when you're a public health official, you want to do something drastic in a situation like that,. If this were an infectious disease, and I came to you and said, I have four index cases of 19-year-olds who have this illness, and they shouldn't have it for 40 or 50 years, what would you do? You would start a quarantine or something. You would start some type of a mass program to prevent it.
And I think that that's the kind of response you're seeing from the Department of Health to try to protect people. That's really what they're trying to do. People are looking at this [INAUDIBLE]. They're trying to protect people from this. And this is one response. And again, I don't want to make it sound like we're talking about something that's overly dramatic. But when you're a public health official, there are only certain things that you can do.
Here's the point I'm making. Like when you're a regulator, there are only certain things that you can do. You can't tax something. All you can do is try to control the things that you can control. I work with the Food and Drug Administration all the time. They can only do certain things to regulate medications. They can't do everything they would like to do because the rules they have only allow them to do certain things.
And like sometimes, we can't understand what they're doing. But after years of working with them, you see that they do this because they can-- once they approve a drug, they actually can't take it off the market. They can't. They have to ask a company to do that. No one really understands that.
So that's why they've gotten-- why they've made it so difficult for drugs to get approved, because they can't take a drug off the market. So people like myself have said, fine. Make it possible for them to take a drug off the market so that we can have more medications. And then if there's a problem, take it off the market sooner. We don't want a company selling something that's not good for people. Do you understand what I'm saying?
AUDIENCE: Sure. I'm also wondering about-- there's talk about a size at the movie theaters, they're not small enough. So wouldn't the other angle be somehow forcing movie theaters and restaurants to make available smaller portions, instead of taking away the larger portions?
LOUIS J. ARONNE: You know, again, I'm not a regulator. I don't know how the regulations can work and what can be regulated. But again, the second part of this is the economic incentive. So I'll tell you about a little experiment I did with my daughter when she-- she's 25 now. She was much, much younger. And this was back in the '90s.
And back then, they still had small, medium, and large soda. And small was $0.70. A medium was $0.80. And a large, which was twice the size, was $0.90. But it was only $0.20 more. She was like eight or nine years old. I said, which soda should we get? She said, what am I, stupid? Do you think I'm stupid, daddy? The large soda. Like an eight or nine-year-old can do the math and figure out that the large soda is the soda to buy.
So the economic incentive, I think, also is there. So is a government, a city government, going to regulate that you can't have an economic incentive in sodas? That I think is not realistic. That is onerous. Unless they were to tax-- the bigger the size portion, the more the tax. I think that's where it's getting difficult. So I think they're trying to regulate what they can regulate.
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New York City Mayor Michael Bloomberg proposes to ban large, sugary soft drinks, in order to curb obesity, facilitate nutrition and rid the city of large doses of empty calories. In advance of the Mayor's soda ban hearings, Dr. Louis Aronne, Carol Parker-Duncanson and David Just met at a journalist-only luncheon to discuss issues in the proposed ban.
Carol Parker-Duncanson - Nutrition and Health Program Leader for Cornell Cooperative Extension-NYC. She implements large-scale community based nutrition programs in the city, and nutrition education training programs. She teaches menu planning, food budgeting, feeding children, developing healthy recipes and making healthy choices. Louis Aronne, M.D. - Clinical Professor of Medicine at Weill Cornell Medical College, where he directs the Comprehensive Weight Control Program, a state-of-the-art, multidisciplinary obesity research and treatment program. Aronne is the former president of the Obesity Society and a Fellow of the American College of Physicians. He wrote the best-selling book, "The Skinny on Losing Weight Without Being Hungry" and edited the National Institutes of Health's "Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults."
David Just - Associate Professor at Cornell's Dyson School of Applied Economics and Management, is co-director of the Cornell Center for Behavioral Economics in Child Nutrition Programs. His work on behavioral economics and the school lunch program shows how low-cost solutions can lead school children to make healthier choices without reducing availability of choices. He is the co-author (with Cornell's Brian Wansink) on a journal article, "The Fixed Price Paradox: Conflicting Effects of 'All-You-Can-Eat' Pricing," in the Review of Economics and Statistics, 2011.