NYC's Top Doc on Bloomberg's Aggressive and Often Controversial Health Mandates

Dr. Eric J. Topol Questions Dr. Thomas Farley on His Provocative Approach to Population Health

; Thomas Farley, MD, MPH

| Disclosures | December 18, 2013

Controversial Health Policy

Dr. Topol: We want to get into some of these. Obviously there has been a lot of controversy in New York City about soft drinks, sugary drinks. Can you tell me what that flap has been about and what has happened with it?

Dr. Farley: First, the biggest problem right now after smoking is obesity and its twin epidemic of diabetes. The smoking rates are going down; obesity rates are going up. This is something I have been focusing on for a long time, and it's a complicated problem. The solutions are not going to be simple, but sugary drinks are probably the largest single contributor to that problem.

The Health Department has focused a lot on sugary drinks in the past few years, and we also know that portion sizes of sugary drinks have a big influence on what people consume. There are good studies that are actually pretty disconcerting, and they show that if you give people larger or smaller portion sizes they will consumer pretty much whatever you give them and don't have any sense of having consumed more or less.

When I was a kid, we used to drink Coke in bottles of 6.5 ounces, and now you can go into a fast-food restaurant and get a 64-ounce cup of soda; that's a 10-fold increase and that's 800 calories. That's a half gallon, by the way. That probably has something to do with how much more soda we are drinking, and that probably has something to do with the growth of the obesity epidemic, so we simply said that if people were served soda in cups that were smaller, like 16 ounces, people could still consume as much as they want because they could buy more than one, but it might also give them a cue that 16 ounces is a more appropriate size than 64 ounces. That rule was presented to the Board of Health. The Board of Health approved it. The Board of Health regulates restaurants in New York City, so it would apply to all the restaurants that they regulate, so we felt and still feel that the Board of Health has the authority to do that. But the soda companies hated it. They sued us. We lost in court. We appealed. We lost the next round, but we still had one more round to go and our lawyers still feel that we have the authority to do this.

The Board of Health has done many other things to protect the health of New Yorkers over the years that have been ground-breaking and incredibly valuable, such as prohibiting lead in paint well before the federal government did it. We think this is in keeping with their authority, and we are still optimistic that we are going to ultimately win in court.

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  1. Dhar M. Did Mayor Mike Bloomberg make New Yorkers healthier? Scientific American. December 10, 2013. Accessed December 11, 2013.

  2. Ebbeling CB, Swain JF, Feldman HA et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012;307:2627-2634.

  3. National Salt Reduction Initiative. New York City Department of Health and Mental Hygiene. Accessed December 10, 2013.

Authors and Disclosures


Eric J. Topol, MD

Director, Scripps Translational Science Institute; Chief Academic Officer, Scripps Health; Professor of Genomics, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape

Disclosure: Eric J. Topol, MD, has disclosed the following relevant financial relationships:
Serve[d] as a director, officer, partner, employee, advisor, consultant, or trustee for: AltheaDX; Biological Dynamics; Cypher Genomics [Co-founder]; Dexcom; Genapsys; Gilead Sciences, Inc.; Portola Pharmaceuticals; Quest Diagnostics; Sotera Wireless; Volcano
Received research grant from: National Institutes of Health; Qualcomm Foundation

Thomas Farley, MD, MPH

New York City Health Commissioner

Disclosure: Thomas Farley, MD, MPH, has disclosed no relevant financial relationships.

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