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February 1, 2013

SC chief health officials eye food stamp soda ban

Seeking to slow the childhood obesity epidemic, South Carolina health leaders would like to limit the purchase of sugar-filled drinks with food stamps.

Catherine Templeton, director of the Department of Health and Environmental Control, and Lillian Koller, director of the Department of Social Services, have exchanged thoughts on the subject. They agree that cutting the intake of sugary drinks could improve the health of the state’s children, but they are struggling with how to use the food stamp program as a tool in that effort, and especially with whether the federal government will allow it.

Several similar efforts, most notably by New York City, have failed to gain approval from the U.S. Department of Agriculture, which runs the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. The feds told New York in 2011 that they agree with the goal of limiting intake of sugary drinks, but the city’s proposal had operational challenges and impacted too many people. They suggested a test program on a smaller scale.

Might South Carolina, or several counties in the state, be the right size for a test case? The state has plenty of SNAP recipients (about 875,000) and way too many obese people (about 1.6 million, based on estimates that one-third of the state is obese).

Templeton would like to see the state try something to reduce the intake of sugary beverages. She says the state and federal governments are ultimately “feeding” the obesity epidemic on the front end through the SNAP program and then spending billions on the back end in treatment for the health issues caused by obesity.

Templeton recognizes she will face opposition from the beverage industry and from people who resist any effort by the government to be food police. She isn’t trying to prevent people from buying soft drinks, just trying to stop paying for those drinks with public dollars.

“You treat your body the way you want to treat your body,” Templeton said. “But the government shouldn’t be subsidizing it.”

Templeton contacted Koller, whose agency handles the SNAP program in the state, for help with breaking the cycle of increasing obesity and increasing health care costs.

“I am charged with finding ways to address the obesity epidemic in South Carolina,” Templeton said. “One way is by reducing the poor quality of nutrition available under the SNAP program.”

Koller pointed out that the state would have to get a waiver from USDA to allow for changes in the SNAP regulations. The state would have to come up with some more focused plan than those tried by previous states. Koller suggested targeting only households with children in them.

Templeton suggested narrowing the scope with trial runs in only a few counties. She has been working to bring more state resources to anti-obesity efforts in three poor counties with high rates of obesity and few anti-obesity programs – Bamberg, Fairfield and Lee. Those counties, with about 17,000 SNAP recipients, could be test cases for a ban on using SNAP funds for sugary drinks.

Koller also brought up the idea of a two-pronged approach, discouraging sweetened drinks while encouraging healthier food. Some advocates have pushed for doubling the amount of SNAP funds when people use them for purchasing healthy foods such as fruits and vegetables. That’s already done at some local farmers markets in a program approved by the USDA.

Templeton agrees with that goal, but she said it might be better to focus only on sugary drinks for a test case. Limiting the scope of any waiver would seem to be a key to gaining approval. The USDA’s response to New York City noted it would impact hundreds of thousands of households. “A change of this significance should be tested on the smallest scale appropriate to minimize any unintended negative effects,” the response noted.

New York City called for banning use of SNAP funds for any drink with more than 10 calories per eight ounces, with exceptions for 100 percent fruit juices and milk. That would have ruled out using SNAP funds to pay for most nondiet soft drinks, as well as many energy drinks and sports drinks.

The USDA also noted the challenges in getting retailers to implement the restrictions and the need to collect health data to make sure the effort is working.

South Carolina has no shortage of researchers who would get behind such a project. Templeton already has broached the subject with University of South Carolina president Harris Pastides. USC in Columbia and MUSC in Charleston have multiple ongoing obesity-related studies.

Teresa Moore, who teaches about nutrition in USC’s Arnold School of Public Health, would like to see progress on the effort to slow the intake of sugary drinks. “I think we should limit them,” she said. “They are empty calories.”

But she noted it’s difficult to convince people to cut intake of sugary beverages when they are much less expensive than beverages that are healthier for children, such as juices and milk. Limiting use of SNAP funds for sugary beverages could change that equation for the state’s poor.

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