Father knows best: Michael Bloomberg’s public health obsession

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Two weeks ago, New York Mayor Mike Bloomberg was consumed with anxiety: Had a right-wing loon attempted to blow up some of his New Yorkers as they waded through the sea of sweaty corpulence that is Times Square on a summery Sunday afternoon? Those Tea Partiers hate health care, after all, and for the last nine years, Bloomberg has done his best to make New York a health-conscious city.

Turns out, the answer was no. But even with New York safe from a jihadi-made car bomb, Bloomberg still has a lot to worry about. Are his people at risk of hypertension from eating in restaurants that serve salty dishes? Have any of his children developed a lump — in her breast, under his armpit, in a place where lumps cannot be detected by prodding alone — from consuming trans fats? Also, why are so many New Yorkers still not rail thin?

These concerns keep Mayor Bloomberg, America’s most successful nanny, up at night, while irritating the hell out of his critics, who believe the mayor has an unhealthy obsession with his own (thinness), and is oblivious to the failings of New York’s public health initiatives.

“Bloomberg seems to be a sort of a classic example of somebody who has the particular obsessions of the upper class when it comes to health issues,” said Paul Campos, a professor of law at the University of Colorado and author of The Diet Myth. “In particular, he seems obsessed with weight.”

While you can still eat quite well in New York, you can’t eat just anything, and you can’t eat anything any way you want. Trans fats are illegal and chain restaurants with 15 locations or more are required by law to include calorie information on their menus.

“You basically have people who have a kind of personal, neurotic relationship to their weight, who then turn this toward public health policy,” Campos said. “This business with calorie counts, and other initiatives, seems to speak to the idea that people are too fat; especially the idea that making people thinner is a reasonable goal for public health intervention. It would make no sense whatsoever if people weren’t projecting their own neuroses on the data.”

The credit for Bloomberg’s initial nannying goes to Thomas Frieden, whom Bloomberg hand-picked in 2002 to head up New York’s Orwellian-sounding Department of Health and Mental Hygiene in 2001. Frieden, an expert on contagious diseases, was behind the city’s cigarette ban and the creation of a needle exchange. When Bloomberg gave Snapple the contract to stock public schools with juice — under the impression, of course, that juice is better than soda for the city’s future mayors — Frieden complained that water would have been even better.

Three years later, Frieden instituted new regulations that mandated calorie counts for chains with at least 15 restaurants, insisting that New Yorkers wanted — nay, needed — calorie counts. “Not everyone will use it, but many people will, and when they use it, it changes what they order, and that should reduce obesity and, with it, diabetes,” he told the Times in 2007. After crafting the new regulations, Frieden’s only obstacle was gaining the city health board’s approval. Luckily, he was the board’s chair, and all of its members were appointed by Bloomberg. The regulation passed in 2008, and now New Yorkers have to think about the caloric content of what they’re eating even if they don’t want to.

Frieden left for the CDC in May 2009, laying the groundwork for a soda tax before he turned out the lights in NY. “‘It is difficult to imagine producing behavior change of this magnitude through education alone, even if government devoted massive resources to the task,” Frieden wrote in the New England Journal of Medicine. ”Only heftier taxes will significantly reduce consumption.” Perhaps hoping that New Yorkers could actually be cajoled into agreeing, Frieden added that a soda tax in New York could possibly save all of mankind from its vices: ”Diet-related diseases also cost society in terms of decreased work productivity, increased absenteeism, poorer school performance and reduced fitness on the part of military recruits.”

Despite Frieden’s public proselytizing, it’s often the mayor himself who gets cited for making New York so health-conscious. “If he can take credit for nothing else,” gushed the New York Times’ Jane E. Brody in January, Bloomberg “can rightfully claim to have launched a national effort to help people live more healthfully.”

Actually, Bloomberg was merely adapting early-20th century reform techniques to the modern era. Early reformers were “quite successful at eradicating disease,” says Jacob Sullum, author of “For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health.” The problem, he points out, is that public health threats like typhus, botulism and DDT have largely disappeared. What remain are diseases like cancer, heart disease and adult-onset diabetes, “things that involve a whole bunch of different lifestyle variables; things that people voluntarily do.” Changing these behaviors is a lot more complicated than posting meat inspectors in slaughterhouses. And it requires far more coercion.

Bloomberg initially disagreed with Freiden’s soda tax proposal, telling the Times in 2007 that a soda tax “‘is just not one that we’re going to be pursuing.” But the mayor’s conscience eventually got the best of him. Less than a year later, Bloomberg heartily endorsed the soda tax. “The soda tax is a fix that just makes sense,” he said in a March 2010 radio address. “It would save lives. It would cut rising health care costs. And it would keep thousands of teachers and nurses where they belong: in the classrooms and clinics.”

Few people complained about Bloomberg’s changing position, Campos said, because the mayor played the ultimate trump card: child welfare. “Child obesity is a classic moral panic,” Campos said. “The fact that childhood obesity is a huge health crisis is one of these things that’s known to be a case, even though the evidence for that is essentially nonexistent. I really do think that what you are looking at here is a sociological phenomenon where people like Michelle Obama,” who recently spoke out against childhood obesity,” and Bloomberg are playing out their own dramas. Michelle Obama is obsessed with her weight, and obsessed with the weight of her daughters. It’s upsetting that that kind of upper class drama gets put into public policy with no filter at all.”

Bloomberg is also playing out an upper-class drama, argues Campos, one that has to do with his less wealthy antecedents. “Bloomberg probably believes he’s a gazillionaire because he can deny himself donuts, and that the reason poor people aren’t is because they can’t.

“Especially in NY, or in Manhattan, thinness is associated with status. People value it for that reason. And they forgot that it’s another form of conspicuous consumption, and it gets turned into an extremely important and desirable public health goal.”

The data don’t confirm Campos’s theory about the roots of Bloomberg’s policies, but they do confirm that those policies aren’t working. “Studies that look at consumption pre- and post-calorie counts are equivocal at best,” Sullum said. “And those kinds of studies can’t take into account how people behave outside the restaurant.”

Yet a fashionably skinny New York remains Bloomberg’s goal. After Frieden left for the CDC in Atlanta, Bloomberg brought in Thomas Farley, Frieden’s calorie-counting protege, to shore up the mayor’s argument for a soda tax.

“The sugar-sweetened beverage tax is absolutely the right policy to enact at the right time,” Farley said less than a year into his new job. And with a one-cent-per-ounce tax under consideration in Albany, Bloomberg and Farley are already moving on to their next target: salt.

“It’s an unknown how to do this at the population-wide level, which is the level of public health policy,” Campos said. “Trying to make fat people thin is based on the assumption that we can do something that we actually cannot do.”

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