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BLOG: Sweet summer thoughts
Philadelphia has been a hot bed of political activity and important social issues this summer. Our “founding brothers” would be so proud.
Of course the Democratic National Convention captured most of the limelight, but for the home crowd, the large political battle was over the city’s proposed tax on sugary beverages.
The so called “soda tax,” a 1.5% per ounce tax on sugar sweetened and diet beverages is the first such tax imposed by a major city in America. The money is earmarked for an expansion of early childhood education. The measure passed city council by a vote of 13-4 in spite of the $5 million spent by the American Beverage Association to block the measure.
The actions of the American Beverage Association are reminiscent of the work of the tobacco industry in fighting cigarette taxes. The first cigarette tax in America dates back to 1864 and was used to raise funds for the Civil War effort. Today, the World Health Organization views tobacco taxes as a public health tool. Likewise, the American Public Health Association has published a number of polices in support of taxes on sweetened beverages.
Obesity is a major health problem in America. In recent data from 2011-2012, 68.6% of Americans were overweight or obese. Alarmingly, that number for children is 31.8%. The obesity rate for children is not evenly distributed over race and ethnicity. In Latino children the rate is 26.1%, and for black children the rate is 23.8%. White children have a 13.1% rate. The rate is also unequal for socioeconomic and educational factors. Americans with higher annual incomes have a lower obesity rate, while lower paid citizens have a higher rate. Among those with college degrees the rate is 9.5%, while those with no high school diploma have a 30.4% rate of obesity.
As primary health care providers, optometrists must develop a clinical approach to this problem. Although this would seem simple, the issue of discussing weight, diet and exercise with an obese patient with totally normal eyes is awkward, inappropriate and borders on being rude or judgmental. The key to this discussion is having collected vital signs as part of the clinical database.
A review of the data collected at the encounter that includes an unhealthy body mass index (BMI) is a perfectly appropriate clinical conversation. This removes the problem of making an “eyeball judgment” of your patient’s weight and minimizes the risk of body shaming based on physical appearance. Often these same patients will have a high blood pressure reading or evidence of sugar imbalance from a finger stick glucose reading or increased autofluorescence of the lens with ClearPath (Freedom Meditech) testing. In these cases, a further discussion about hypertension or diabetes and related eye sequela is obvious. The management plan in all of these cases needs to start with diet and exercise as the first step.
All Americans must take a hard look at the obesity epidemic in America. It is a problem that is quickly becoming one of leading factors in the premature death and disability of our citizens. Over the past 50 years, we have successfully reduced the national smoking rate with education, the banning of cigarette commercials and, of course, the tobacco tax. We must follow suit with a war on sugar.
As optometrists, we must do our part in the examination room by measuring vital signs and adding a discussion about BMI, diet, nutrition and exercise when appropriate to our “doctoring.” Together, we can all contribute to a healthier America.
References:
Otterbein H. www.Phillymag.com. Meet the dark money forces behind Philly’s soda tax. June 27, 2016.
World Health Organization. Innovative financing for health: Tobacco taxes. Accessed August 9, 2016.
American Public Health Association. Taxes on sugar-sweetened beverages. Accessed August 9, 2016.
The trust for America’s health and the Robert Wood Johnson Foundation. The state of obesity. Accessed August 9, 2016.