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Last updateWed, 27 Sep 2017 1pm

A teenage girl walks the hardscrabble streets of Richmond, a Bay Area city, rapping about the challenges of drugs, violence—and diabetes.

Here, she says, big dreams are “coated in sugar,” and innocence is “corrupted with Coke bottles and Ho Ho cupcakes.”

She’s performing in a video by a local youth group that counts diabetes—a national epidemic that has hit California hard—as one of the killers in her neighborhood. The disease, which is spreading and driving up health costs, now impacts more than half of the state’s adults, especially people of color and the poor.

Experts say it doesn’t have to be that way—that prevention programs can slow the march of the illness and save money at the same time. But efforts to legislate prevention—for example, taxing the sugary drinks whose consumption contributes to diabetes—have stalled in the face of heavy opposition by the well-funded beverage lobby.

The state will soon begin funding a program for anti-diabetes education, counseling and lifestyle coaching, but it’s a modest investment regarded only as a start.

“Investing more now in diabetes prevention and education will save our state billions of dollars down the road,” said state Sen. Bill Monning, a Democrat from Carmel who has proposed soda taxes in the past, and tried unsuccessfully this year to require warning labels on sweetened drinks.

A UCLA study last year found that 9 percent of adults in California have been diagnosed with diabetes, a chronic condition in which the body does not process sugar well, which can lead to blindness, heart disease, stroke and infections resulting in amputations. Forty-six percent—including about a third of those under 40—are pre-diabetic, with elevated sugar levels that will likely develop into diabetes.

That’s 55 percent of the state’s adult population swept up by the disease.

Treating diabetes costs government, private insurers and patients about $27.6 billion a year in California, for such expenses as doctor visits, testing, medication, surgery and hospital costs, according to the American Diabetes Association. The state and federal governments shoulder most of that expense through Medi-Cal, California’s health program for those living in poverty, as well as the national Medicare system that covers seniors.

A state audit of the California Department of Public Health diabetes-prevention efforts released two years ago said that California lagged in such spending. The state spent about $1 million from the federal Centers for Disease Control and Prevention, a sum that has since grown to $1.4 million, but did not devote state money to programs. New York, the audit points out, was spending $7.2 million, although some of that money went to anti-obesity programs.

Beginning in July, with the next budget, $5 million in state funds will go toward a nutrition and exercise program for pre-diabetic enrollees in Medi-Cal. That project, based on a CDC model called the Diabetes Prevention Program, can cut the risk of developing diabetes in half, according to the CDC. In addition, it is expected to save about $45 million in treatment expenses over the next five years, said Assemblyman Joaquin Arambula, a Kingsburg Democrat and physician who co-chairs a health subcommittee.

Flojaune Cofer, an epidemiologist and director of state policy and research for the nonprofit Public Health Advocates, said that about 25,000 people will be able to participate each year.

“We can’t just wait until people get sick, because it’s not a viable system,” Cofer said.

The largest state pension fund, CalPERs, began offering the CDC program to through its insurance plans this year, and Medicare will offer it nationally next year. It is also offered by some private insurers.

But adult-onset diabetes, or Type 2, doesn’t get the same attention as some other deadly diseases, such as cancer. Nor is it considered as blameless as Type 1 diabetes, a childhood disease diagnosed when the body produces little or no insulin.

Type 2 is considered mostly preventable by changes in diet and physical activity. But its spread has increased 32 percent in California in the past decade, according to state statistics. The disproportionate impact on low-income communities and people of color may partly explain why it gets short shrift, experts say.

“There’s a general belief that it’s slothful, lazy people making bad choices,” said Dean Schillinger, professor of medicine at the University of California, San Francisco; he’s a leading expert on diabetes and prevention, and was chief of the state’s diabetes-control program from 2008 through 2013. “But if you have to choose between buying a fast-food meal for your family of five for $15 or going to Whole Foods and spending $80 on health food, it’s very rational what people are doing.”

Add to those economics the marketing of beverages and snack foods to children, especially through targeted advertising in low-income communities, and you have a natural intersection for the disease, he said. A federally funded study released this year found that diabetes grew at a rate of 4.8 percent among children each year between 2002 and 2012.

“It’s an unacceptable state of affairs,” Schillinger said. “We can and must do something to prevent young people from having an amputation or being blind by the age of 30.”

Diabetes is also increasing among white people, Schillinger noted, just not as quickly. Sedentary lifestyles, fat-rich diets and time spent in front of screens large and small cut across all communities.

Another contributor is a health care industry that has been primarily focused on treatment instead of prevention, said Monning: “Prevention, including diabetes prevention, is not profit-generating.”

He and a handful of other state legislators have been trying to pass measures to slow the growth of diabetes for years, focusing on the role of sugar-sweetened beverages—because they are the leading cause of increased calories in children. The lawmakers’ targets include not just sodas, but also other sugary drinks camouflaged as more healthful: sports drinks, juices and enriched waters.

Monning tried this year to require labels on certain drinks to state that “drinking beverages with added sugar contributes to obesity, diabetes and tooth decay.” Other efforts have involved a statewide tax on such drinks, but that requires a two-thirds vote of the Legislature and has been a hard sell.

The beverage industry argues that the causes of diabetes are complex, involving much more than soda, and that the best way to build strong, healthy communities is to work together to “help people balance their calories and improve their diets,” said Lauren Kane, a spokeswoman for the American Beverage Association.

The group says taxes don’t work, and labels are misleading.

“America’s beverage companies are already helping people cut their sugar intake from beverages through our collective efforts to reduce portion sizes and introduce smaller, more convenient packages with less sugar,” Kane said.

But Monning blames the industry for pushing hard enough—and spreading enough money around Sacramento—to scare off the “yes” votes needed to pass preventive measures. The beverage group has spent $282,000 on lobbying in California so far this year, according to its required reports to the state. The two largest soda makers, PepsiCo and Coca-Cola, have spent about $248,000. And in the last five years, PepsiCo and Coca-Cola have contributed nearly $783,000 to state candidate campaigns, while the American Beverage Association gave $135,000, the filings show.

 There has been a slight decline nationally in the consumption of soda, studies show, although the void may be at least partly filled with other sweet drinks. Experts credit local measures to tax sweetened beverages and require warning labels on billboards that advertise them, among other moves.

Such taxes have been imposed in Berkeley, San Francisco and Oakland. Other cities, including Richmond, have tried and failed to pass them. San Francisco approved a requirement two years ago that certain beverage ads be labeled, but the beverage industry sued to block the measure in a case that is ongoing.

More local taxes and labeling requirements could prompt state lawmakers into action eventually, as plastic-bag bans throughout the state did, said Monning. Once a tipping-point number of cities outlawed the bags, it became easier for the Legislature to adopt a statewide policy.

Schillinger said he has seen firsthand that prevention efforts can stem, or even reverse, an epidemic tide. When he started his medical career, at the height of the AIDS epidemic, half of his patients were dying from HIV infection, he recalls. Within 15 years, that epidemic was pushed back by a combination of grassroots activity, well-funded public health work and scientific research, he said.

“At that time, one out of 15 to 20 of my patients had diabetes,” he said. “Flash forward, and I have no patients with AIDS who are dying. Our AIDS ward is empty. But instead, we have the diabetes epidemic,” and half his patients have the disease.

Schillinger lauds community awareness efforts, like the videos posted by Youth Speaks as part of its diabetes-prevention program. Even armed with statistics and an M.D. degree, Schillinger said, he has participated in too many disappointing policy discussions with lawmakers about diabetes.

“There has to be a different way to talk about this,” he said, “and it has to come from different people.”

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

The metal tab pulls back with a familiar click-click-hissssss as bubbles rush to the top of the can. The alluring scent wafts through the air, a familiar smell that hints at what’s to come.

If you’re drinking a 20-ounce Mountain Dew, you’re consuming the equivalent of 18 teaspoons of sugar. A same-sized Pepsi equals 16 teaspoons, and a Coke comes out to 15. A 16-ounce Rockstar Energy Drink slams more than 15 teaspoons.

Here’s the problem with what you’re drinking, some scientists say: Humans are not biologically designed to deal with that much liquid sugar at once. Since there’s no digestion involved, it enters the bloodstream and is absorbed more quickly than food.

As it does, the sugar overwhelms the pancreas, the organ tasked with regulating blood sugar, and over time wears it out. Welcome to Type 2 diabetes.

Harold Goldstein, a doctor of public health, is the founding executive director of the California Center for Public Health Advocacy (CCPHA), a Davis-based nonprofit whose mission is to look for solutions to what scientists say is an alarming increase in diabetes and obesity in California.

About five years ago, the CPHA commissioned a study by the UC Center for Weight and Health to see if there was a correlation between obesity and sugary beverage consumption.

The UC study found that Americans on average were consuming 278 more calories a day than they were about 2 1/2 decades before, with 43 percent of those calories defined as new beverage calories.

“I had no idea what the answer was going to be, but what they came up with was simple and compelling,” Goldstein says. “I was stunned. It was twice as much as I guessed.”

We weren’t just eating more. We were drinking more. And mostly, we were drinking more sugar, a phenomenon that coincided with the “soda wars” of the ’70s and ’80s, where Coca Cola and Pepsi went head-to-head on television advertising campaigns. It also coincided with an increase in portion sizes: In the ’70s and ’80s, a 12-ounce can was the norm. Now, fast-food restaurants offer 32-ounce cups with free refills.

Another surprising statistic, this from the National Institutes of Health, via Goldstein: A quarter of teenagers, or 23 percent, have pre-diabetes, an increase from 9 percent just 10 years ago.

“These beverages are tricking the body,” Goldstein says. “The pancreas goes wild and the liver says, ‘Look at all this. I’d better save it for a rainy day and turn it into fat.’ There is a cohort of teens that will be entering the health-care system with higher rates of diabetes than ever.”

The grim statistics are why state Sen. Bill Monning, a Carmel Democrat, backed by CCPHA and the Health Officers Association of California, continues a battle with the beverage industry.

On Feb. 11, Monning introduced Senate Bill 203, which would have required a warning label to be placed on the packaging of sugar-sweetened beverages including sodas, sweet teas, sports drinks and energy drinks. The label would have been required on drinks with 75 or more calories per 12 ounces and would read as follows: “STATE OF CALIFORNIA SAFETY WARNING—Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.”

However, the beverage industry was willing not only to put a lot of muscle and money behind the effort to stop him, but also to try to stop information they deem harmful to their industry from reaching the public—and their efforts paid off on April 29, when the bill was effectively killed by Senate Health Committee. Only four of the nine members voted for the bill; one senator voted against it, with four abstaining.

Last June, on the same day Bill Monning’s previous labeling bill died in the state Assembly Health Committee, PepsiCo spent $2,200 on a catered event for 13 legislators and more than three-dozen legislative staff members from the Latino Legislative Caucus, as the Sacramento Bee reported. Of the legislators who attended, two voted against SB 1000, the previous iteration of the labeling bill.

In 2014, the American Beverage Association California Political Action Committee, also known as the American Beverage Association Strategic Advocacy Fund, spent $11.8 million on various candidates and measures. Of that, $9.24 million went to the successful opposition of a soda tax floated before San Francisco voters. The group also spent $2.43 million to defeat a Berkeley soda tax, which passed despite fierce industry opposition.

The PAC donated $4,100 to Luis Alejo, D-Watsonville, who this year became head of the Latino Legislative Caucus, and the same to the Senate campaign of Ben Hueso, the San Diego Democrat who is vice chair of the Latino Legislative Caucus.

It put $27,200 into Gov. Jerry Brown’s campaign and $3,000 into Attorney General Kamala Harris’, too. It gave $46,000 to the Democratic State Central Committee of California and $10,000 to the California Republican Party.

Fast-forward to this year. The PAC started 2015 with $504,000 in the bank. The spokesman for the Latino Legislative Caucus PAC and foundation, Roger Salazar, is now the spokesman for CalBev, also known as the California-Nevada Beverage Association, the trade association representing the non-alcoholic beverage industry in California and Nevada. The Cal-Nev Soft Drink Association PAC spent $37,371 on various campaigns in 2014, mostly as $1,000 contributions to individual legislators.

In the hours and days that followed Monning’s announcement of his labeling bill, CalBev went on the offensive.

In a written statement, CalBev Executive Director Bob Achermann said obesity and diabetes are more complicated than a warning label. Monning’s bill is “misguided,” and singles out soft drinks while ignoring sugar-rich cupcakes, donuts and processed foods. It’s also riddled with loopholes that will confuse consumers, according to the statement.

For example, the release says, fountain sodas purchased at restaurants with table service will be exempt from labeling. The release also calls out milk-based products like Frappuccinos and lattes, which contain as much sugar and more calories than soft drinks.

Salazar says the industry has taken on an initiative to reduce sugar-sweetened consumption 20 percent by 2025.

“There are ways you can have a collaborative effort, but bills like this seek to demonize an industry with a shocking label when there are other, broader causes to obesity and diabetes we should be looking at,” Salazar says. “It’s about balancing calories, and there’s no question we support programs that educate people about nutrition and exercise.”

But the statement that there could be a collaborative effort came as news to Monning.

“They haven’t proposed any compromises to us that would work for them,” Monning says. “I think we’ve maintained open and cordial conversation. Their position on labeling is: They provide caloric information on the label, and consumers have that at their fingertips.”

Monning acknowledges other sources of sugar are out there, but says none are as dangerous.

“While sugar is in other foods,” he says, “medical evidence is clear that liquid consumption of sugar is more immediately damaging. When you eat it, more is eliminated through digestion.”

A version of this story first appeared in the Monterey County Weekly.

Published in Politics