Diabetes and metabolic syndrome

Diabetes and metabolic syndrome

Case 15: Access to Sugary Drinks: A Tale of Public Policy

Relevant Professions: Public Health, Medicine, Nursing,


Issues: Diabetes and metabolic syndrome, School policy.

Why this is important: Diabetes is a major health problem in the US. Proposed

ways to reduce diabetes rates are very important. But often raise the issue of the

conflict between freedom of choice versus the greatest good for the greatest


An Arlen Independent School District (AISD

The case: An Arlen Independent School District (AISD) Board Meeting is

scheduled to vote on a controversial issue. Whether to ban all sugary drinks from

high school grounds. Three experts are called into provide testimony.

By now, the connection between high consumption of sugary drinks and weight

gain was viewed as conclusive by most Members. The weight of evidence also

pointed to heightened risk of obesity and Type II diabetes among high, daily

consumers. Soda machines had already been removed from all of the primary

grades by letting their contracts lapse with distributors. High Schools were different since more was at stake financially and energy and sport drinks replaced soda as the drink of choice among students. Moreover, high school students were approaching adulthood and legally permitted to drop out at 15. And yet, the political trend in Colorado was toward some kind of action; it was named the thinnest state in the Union in 2001 and saw its reputation threatened as the newest cohort of teens

weighed in. Opponents to any Board action to restrict access had maneuvered to

have the strongest form among the proponents’ measures—a ban—put on the

agenda for an up or down vote. Consideration of any substitutes would be postponed

until after the pending School Board election.

The first expert was Daniel Lit, an exercise physiologist with the state’s

Department of Parks and Recreation

Department of Parks and Recreation. He addressed what many viewed as an

unintended consequence. If sugary drinks were banned on school grounds without

exception, then sports programs would have a very difficult time addressing

dehydration in Arlen’s altitude, especially during spring and fall seasons when high

temperatures made this problem a deadly serious one. He believed that the solution

for obesity prevention was to mandate participation in sports for all students. He

also reminded Members that income from drink sales and vending machine franchises

were a key revenue source for keeping sports and physical education programs

alive in rural areas.


Donna Deckle an epidemiologist from the University Medical Center spoke

next. She cited recent data on the average ingestion rates: sugary drinks were the

number one source of calories in this age cohort’s diet, responsible for more than

half of all the added sugar they consumed. She argued in favor of the ban to protect

these children from the dangers that sugary drinks pose to their future health. She

had no confidence in the effectiveness of measures short of eliminating access for

anyone under 18, as had been done with alcohol and tobacco. She also cited some

experimental evidence suggesting that high sugar consumption was addictive.

health economist

Burt Redone, health economist with the Federal Reserve, advanced an argument

for a substitute motion. He believed that banning was too expensive to implement

and enforce. The simplest alternative was to raise the price of drinks to a level that

would discourage consumption. His calculations pointed to a doubling of the price

as the right value. He thought that the higher price would be an effective signal to

young consumers that their sugar intake needed to be rationed. He pointed out that

this had worked quite well with tobacco sales and would translate easily to the

vending machines without jeopardizing existing contracts with drink distributors.

In an unusual move, the Mayor of Arlen, Sophia Villarreal, requested time as an

expert. She pointed out that the opinion polls were against this ban and counseled

the elected Board Members to heed the views of their constituents. She drew some

applause when she stated that the way to get children to make responsible choices

was to give them guidance and then opportunities to make the right choices. She

was not averse to posting information or warnings if the science was there, but

thought that more aggressive intervention was both misguided and inconsistent with

community norms and values.



1. What ethical arguments is each of the experts making?

2. What are the pros and cons of each of these arguments?

3. How should this case best be resolved?