Transcript of Episode 7: Healthy Beverage Zone

with host David Richards [DR] and guest Dr. Vanessa Salcedo [VS]  
Listen to the audio

[DR] This week on the Healthy Communities podcast we’re going to talk about the health impacts of sugary-sweetened beverage consumption with Dr. Vanessa Salcedo, pediatrician of Union Community Health Center in Bronx, New York. We’ll see why we should all rethink our drink.

[DR] Welcome to the Healthy Communities podcast; a public health-themed podcast that breaks down common health issues in our communities, and how Healthiest Cities & Counties Challenge projects aim to address them. I am your host, David Richards from APHA. This is Episode 7: Healthy Beverage Zone.


[VS] I am Vanessa Salcedo, a pediatrician by training and I’m also director of health promotion at Union Community Health Center in the Bronx.

[DR] Great, so there are a lot of different sides of medicine. Why did you choose the public health side?

[VS] In medicine, it’s great; we make an impact on a person and individual basis, but I also wanted to make a bigger impact in the community that I serve. That’s why I was really interested in public health. Really, when it came to the Healthy Beverage Zone, the inspiration was from my patients because on a daily basis, I see my patients drinking these sugary beverages. The parents were not aware that these drinks are bad for them. They really thought that the fruit juices were good for them. Not only was I seeing them drink them on a daily basis, but I also started to see a lot of the health consequences in my teenagers. I had teens that I had to send for liver biopsy from fatty liver disease at the early age of ten. I was seeing a lot of teenagers with prediabetes. These are health impacts that I was seeing in my community which I wanted to educate them about. 

[DR] You said in your background materials that the South Bronx has among the highest consumption of sugary beverages, where 27.8 percent of residents in the South Bronx consuming at least one sugary beverage daily.

[VS] In general, Americans drink about one sugary beverage a day. In the Bronx, we drink 3-4 sugary beverages a day; that’s an unfortunate fact that I do know. We know that the sugary beverages are linked to these health outcomes and consequences of different diseases such as diabetes, tooth decay, fatty liver disease and hearth disease that are impacting our community. 

[DR] Just to take it a step backwards, what makes a sugary beverage? 

[VS] Yeah, any drink with added sugar is a sugary beverage. Like I mentioned a lot of my families don’t realize that those fruit drinks are sugary beverages; those sports drinks are sugary beverages; those sweeten teas that they love to drink are sugary beverages. And they’re just as bad as regular soda that we always think about when it comes to sugary beverages. And that’s part of the education piece, is identifying all the sugary beverages. 

[DR] I guess on the physician side, you got into this a little bit but you talked about liver issues and diabetes. Tell me why sugary beverages are bad for you? 

[VS] Unfortunately, in sugary beverages, the excess amount of sugar, you’re drinking liquid sugar, this high fructose corn syrup that is really affecting different parts of your body. For instance, for diabetes, it causes the insulin resistance; for the fatty liver, that’s where the sugar is stored and causes this excess fat in the liver, and people don’t realize, and this is a new phenomenon that we’re seeing more and more that this fatty liver can lead to cirrhosis and then also heart disease because the sugar causes an excess triglyceride. We don’t really realize all the danger that is happening in our body from the sugary beverages. A lot of people also ask me, “Well, why sugary drinks and not a sweet like a dessert?” Unfortunately when it comes to sugary beverages, we just keep on drinking. Our body doesn’t know the difference when stopping because it’s full. When we drink a drink, we can keep on drinking verses a tub of ice cream. Our bodies are going to say no, let’s stop eating this. That’s one of the biggest differences. The other thing is the nutrients. It has zero nutrients. It’s all empty calories that sugary drinks have. 

[DR] That’s a really great point. Really quickly, what is cirrhosis? 

[VS] Unfortunately, the fat in the liver causes inflammation and then the liver fibroses and it pretty much stops working. It’s almost like it keeps on scaring itself. It doesn’t function correctly. You’re slowly losing function of your liver. 

[DR] You said that it manifest decades later? 

[VS] Exactly. A lot of people can relate to alcohol, excess alcohol drinking and how it affects the liver. Drinking sugary beverages is also linked similarly to alcohol in its effects.  

[DR] I think some people would argue that sugary beverages are addictive. Do they have addictive properties, chemically?

[VS] This is a big debate on whether sugar is addictive or not. There is a big body of evidence showing that sugar does release dopamine in our brain which causes pleasure. We do know that the excess sugary, even salts and certain foods change your taste buds. We do develop an inclination for it. Is it addiction? I don’t really know, we don’t really know, but there is definitely evidence that shows it. I think we can all say at some point that we’ve all had a craving for that sugar. As you introduce it early on in your childhood, then you become more accustom to it and then that might also be considered an addictive property. 

[DR] Great. Let’s turn to your area of expertise, the Bronx. In your background materials you mentioned the hashtag #Not62, can you tell us what that means?

[VS] Unfortunately, the Bronx ranks number 62 out of 62 in health outcomes. So what that means is that out of all of New York State, we have the worst outcomes when it comes to diabetes, when it comes to obesity, when it comes to social and economic factors. We’ve ranked for the last eight years. The #Not62 campaign is a campaign for a healthier Bronx. It’s a coalition of different organizations to improve the health status of the Bronx and that’s what we’re all working on slowly. 

[DR] You did mention that you have higher rates of diabetes. One thing that I’m interested in, is how did you determine sugary beverages as the leading cause of the diabetes problem or is it fast food or something else. 

[VS] There is a lot of evidence showing sugary beverages as the leading cause of diabetes and we do know that if you drink one can a day of soda, you increase your risk of diabetes by 25 percent, compared to someone who doesn’t drink any sugary beverage. Right there, as we started off talking that the Bronx, has the highest rate of sugary beverage consumption in New York City. I see it. My patients drink four or more sugary beverages and unfortunately they don’t even drink water. This is part of their daily meals, their snack, their drinking these sugary beverages. The basis of this campaign is that, we feel that if you make a small change, it’s going to improve your health outcome. It’s going to decrease your risk of diabetes and all these chronic diseases. 

[DR] In the background materials I thought that this statistic was fascinating. You said, “according to preliminary data by the New York City Department of Health show that the Bronx sugary drinks ads are twice as more prevalent in impoverished black and Latino neighborhoods,” such as in the South Bronx, “compared to higher income neighborhoods.” How do the ads and the campaigns around sugary beverages influencing drinking? 

[VS] Unfortunately we are a target. Our communities are a target and it is working. You have celebrities and athletes drinking these sugary beverages giving the perception that it’s okay. My patients don’t know that sports drinks are bad. They don’t realize how much sugar is in there. They don’t realize that they’re not supposed to be drinking that when they’re doing exercise and that water is the better choice to drink. Because of the ads, because of the marketing, because of the misperception, the studies show that it’s influencing their behavior. 

[DR] You have said this a couple times now: The Healthy Beverage Zone. What is the Healthy Beverage Zone?

[VS] The Healthy Beverage Zone is a borough wide movement to promote healthy beverages for everyone who lives and works and visits the Bronx. We focus on organizational change and to be the role models for the community. So, we work with different organizations, we have over 50 organizations and they include: churches, community-based organizations, community clinics, hospitals, schools, universities. It’s a very broad range, but they all have the basic concept and model to improve their beverage standards. We have both, what we say is PSE, which is policy, system, environmental changes that will help their organizations improve their beverage standards, and then we have an educational campaign. To let everyone know what the PSE is focused on is, for instance, a community health center with vending machines improving their vending machine to not include sugary beverages. With all the organizations, we asked them to change their meeting policies. If they have a meeting, we ask not to include sugary beverages at their meetings. The second is that we have an educational campaign with the employees with the community or constituents who they serve to educate them on why we’re doing this and why it’s important to exclude sugary beverages, and why we are targeting this specific entity. Those are the things we really focus on. We make it voluntary, so we ask all the employees to take a pledge not to drink sugary beverages, especially when they are at work. These are really influential organizations like I mentioned, these health centers, hospitals, schools, daycare centers, senior centers. They influence the communities that they serve. We feel that it’s really important for us for them to be a role model for the community. If we don’t do it, then how do we expect our community to do it and make these changes?

[DR] Are you using any type of incentives or punishment?

[VS] No. It’s surprising, but it’s all voluntary. We are changing the environment. We are trying to make the healthy choice the easy choice, so that’s the first step. We’re really encouraging everybody to realize the impact that they’re making in their work settings and for the people who they serve. You know, luckily, the majority of the community has been very receptive and they see the problem that we have with diabetes. Once we give them the facts, then they really make this change or at least acknowledge this problem. Like I said, we have a couple of people that are hiding their sugary beverages in their bags and to their colleagues. You’re always going to have these people that say that they’ve been drinking this for their whole life and I’m okay. I think reemphasizing that it’s not only about your health; it’s about the community health. Really being that nurse in the community, your behaviors really influence the people around you. If I’m the pediatrician telling my patient not to drink a sugary beverage, and she turns around to see the nurse who she gets along with drinking a sugary beverage that is really not going to help that patient’s behavior.   

[DR] Who are your champions? Are all 50 your champions? Or is some doing better than others?

[VS] We’ll always have some that are a little bit better than others. I think that capacity is definitely an issue. The smaller organizations have fewer employees to do more activities, but one of the hospitals that we work with has already a wellness committee and they’ve been able to incorporate all of their wellness events with the Healthy Beverage Zone. Whenever it’s nutrition month they highlight the Healthy Beverage Zone, or when they have a food market and farmers market in their hospital, they incorporate the Healthy Beverage Zone. They’ve been able to incorporate the Healthy Beverage Zone in their activities with their walks, and whatever other activities they have. That’s because luckily they have more personnel and capacity. The department of nutrition feels like it’s very important. I think having the capacity and leadership buy in a really key factor in making the Healthy Beverage Zone successful in different organizations.                                           

[DR] Let’s talk about the leadership. The Bronx Borough President Ruben Diaz Jr., the Senator Gustavo Rivera, they have all been allies from the start. What does that mean to be an ally and what are they saying about your program? 

[VS] Talking about elected officials, they have been on board. The Bronx borough president was at our launch and he supports our campaign. Our officials from councilmen to assemblymen and to senator, everyone has really been on board. Especially because of the #Not62 campaign, but they also support us with giving us the credibility and also helping the movement. We admire a lot of our elected officials because they are on the ground, helping the organizations, helping the community. It’s important for us to have them support us at the same time. There are a lot of community initiatives, so we really do appreciate them supporting us and putting the Healthy Beverage Zone at the front for the Bronx. 

[DR] Are they role models for younger students? 

[VS] Exactly. They are role models. As I mentioned, The Bronx Borough President Ruben Diaz Jr., a lot of the community looks up to him. He’s local Bronx side and he’s very attuned with the community and their needs and the culture. It’s great to have him on board as a champion.

[DR] What are somethings that you’ve learned or things that you would have done differently? 

[VS] When we launched the Healthy Beverage Zone in April, we got a lot of momentum and we had a really strong start. One of the things that we didn’t realize was that we we’re going to get this much enthusiasm. One of the challenges was having the capacity to engage all those organizations from the start. 

[DR] Well those are all of my questions about the Healthy Beverage Zone. Do you want to add anything? 

[VS] It’s been great to be part of this Challenge. The Challenge has really helped to unify the Healthy Beverage Zone as a Bronx movement, not as Union Community Health Center, Bronx Department of Health, this is really a Bronx movement and you can see that by the organizations who have signed on and who have committed to the change.                                 


[DR] That’s the show this week! Thank you to my guests Dr. Vanessa Salcedo, and thank you all for listening. Links to more resources can be found on the Healthiest Cities & Counties Challenge website at healthiestcities.org under about the challenge, podcast. I’ll see you next time.

*BONUS Transcript of Episode 7b: Soda Tax Extras

with host David Richards [DR] and guest Dr. Vanessa Salcedo [VS]  
Listen to the audio

[DR] Hi Healthy Communities podcast listeners. This is your host David Richards. In appreciation of your support, here is some bonus content from last week’s conversation with Dr. Vanessa Salcedo. We look at the ingredients of a soda tax. Enjoy.

[DR] If you would like, we could get into soda taxes and stuff like that. 

[VS] Sure. Let’s talk a little bit about it. I do believe in soda taxes. It’s shown evidence in Berkeley and even in Mexico. Different communities that have had soda taxes for over a year have shown a decrease in consumption. One of the recent studies that I show says it’s dropped by 20 percent. It does work. It’s not the end-all be-all. I think a lot of it is education. Behavior change is really hard as we know and different people are motivated by different things. Price might be one of the motivations, but education is definitely a motivation. What we have seen and what has worked, and what I’ve learned about, is that it really has to be a grassroots effort in terms of the knowledge. We can’t have it saying “oh the government is going to impose this tax on us because of xyz. We really need to know why this is happening. Knowing the why has made soda taxes successful. At least that’s what some of the studies have shown when they’ve been unsuccessful like in Cook County, where the tax got overturned. It was because it didn’t have that grassroots educational component that Berkeley did. That’s what we really feel about the Healthy Beverage Zone. If in the future New York City would ever have a tax, I feel at least now, that we’re trying to get the information and bring the educational campaign on why it’s important to do this and we’re really being a target from these big soda companies. It’s really affecting our health. I think that’s really why. I know everyone brings it back to Bloomberg’s big soda tax for large drinks and unfortunately that didn’t go through. That comes down to the same. It was many years ago, it was a new concept. Not a lot of people were aware of the dangers of sugary beverages, as it is more mainstream now. If that would have happened in today’s political climate and today’s soda tax climate and knowledge, I think it would have passed. I think it would have continued. I don’t know what New York City is planning in the future, but until that comes, we just have to educate and have the grassroots element.

[DR] And you did mention that in today’s culture I would have passed, but why do you think that it failed? Was it the lack of education or it didn’t have enough grassroots.

[VS] Yeah. I do believe that. It was more of the size. Talking about the size, what are you targeting? The size made it seem like why am I supposed to drink less. It didn’t really explain. The community did get the wrong message that they were getting rid of their liberty by taking away the size of the drink verses what the drink was. That’s my opinion on it. If we focus more on what the problem is, which the sugary beverages is in general. I want to mention something that I talk to all my patients about is when they ask me, “Do you promote drinking less sugary beverages or cutting down?” I say that I promote zero sugary beverages because it’s the same as smoking cigarettes. I do not tell my patients, oh it’s okay, only smoke one cigarette. It’s the same concept. Sugar and sugary beverages are the new tobacco. The soda companies are similar to how we fought tobacco companies. 

[DR] I think that would be very prevalent in places like Chicago. The large soda companies spent hundreds of thousands of dollars on these campaigns to get rid of that tax.