Although several leading health-care organizations are removing sugar-laden drinks from their vending machines, Mayo Clinic has no plans to follow suit, it has said.
Last week, Health Partners, the third-largest health care employer in the state of Minnesota, said it would soon pull nearly every sweetened drink from its vending machines.The rule kicks in next year limiting sales of sweetened beverages to 20 percent of all purchases, with the long-term goal of selling no sweetened beverages or candy.
It joins the growing ranks of health systems to limit the sale of caloric sweeteners, including Fairview Health Services in Minneapolis, Essentia Health in Duluth, Kaiser Permanente in California and the Cleveland Clinic in Ohio. It's a move similar to hospitals' removal of cigarette sales 40 years ago.
But Mayo, the largest health employer in the state of Minnesota, has no plans to take a similar step with sweetened snacks.
"We strive to provide healthy options for our patients, visitors and staff," the clinic said in a statement, "but there are no immediate plans to ban soda or snacks in vending machines."
The pressure has grown on Mayo to remove the products, however, which have been linked with an epidemic of obesity and rising rates of death from high blood pressure, Type 2 diabetes and heart disease.
"Minnesota's world-class health providers should be at the forefront of this burgeoning effort to discourage drinking beverages loaded with unnecessary sugar," read "A Logical Place to Limit Sugary Drinks," an editorialpublished in the Star Tribune on July 3. "Having Mayo Clinic and Allina Health, two leading Minnesota providers, lend their clout would be especially helpful."
If Mayo did move to ban the sale of sweetened beverages, candy and treats from its vending machines, it would join providers who have determined the evidence linking caloric sweeteners to chronic illness is too great to overlook in the name of offering a range of choices to employees and patients.
"There's a tremendous amount of literature in the medical evidence looking at sugar, how our sugar consumption has increased dramatically and that the single largest source of added sugars in our diet is through our beverages," said Dr. Karla Rosenman, a member of the Better Eating Collaborative at Park Nicollet that helped develop the initiative within HealthPartners.
"We know the more sugar we consume, the higher our rates of chronic disease like diabetes, high blood pressure and obesity. Since beverages are the single largest source of those added sugars, it's a great first step to make to reduce our sugar intake."
Cause 25,000 deaths a year
Sugary drinks are responsible for 25,000 deaths from diabetes, cardiovascular disease and cancer in America each year, according to a widely-reported studypublished last week in the journal Circulation. It causes 184,000 deaths worldwide in the year studied -- including a startling, one-in-three deaths of all Mexican citizens under 45. The results "indicate the need for population based efforts to reduce sugar sweetened beverage consumption," according to authors.
"It's ironic that in hospitals," says Dr. Dariush Mozaffarian, co-author of that study and a cardiologist and epidemiologist who is dean of the school of nutrition at Tufts University,"some of the patient foods have been getting better, but hospital cafeterias and vending machines have some of the worst foods in the country."
"Hospitals should be at the forefront of removing sugary beverages and junk food from their settings. To protect their patients, to protect their staff, to send a message and be a beacon for health in the community."
Despite this research, sugar is still a strong presence at Mayo.
Catering trays at Mayo events still contain cookies, lunches often come with dessert, sheet cakes are still cut into at mid-afternoon Mayo Clinic celebrations, and employee-hosted bowls of candy greet visitors at many departments.
Clinic vending policy is likely a compromise factoring in the demands of hosting a 24/7 workplace and long-held regional preferences for baked treats and sweetened beverages. Clinic visitors come through its doors at a challenging moment in their lives, many of them no doubt hoping to take a break from difficult treatments with the familiar sugar-laden foods that give them comfort.
Internally, the clinic has made strides in offering alternative, healthier fare throughout its patient and employee dining areas. The Dan Abraham Healthy Living Center cafeteria, for example, offers extensive array of whole foods, and strives to educate diners about food preparation as well as feed them.
But the clinic also has scores of vending machines, in dining areas and staff break rooms, offering sweetened sodas including Pepsi, Dr. Pepper and Mountain Dew, a drink that contains 77 grams or 19 teaspoons of sugar; snacks such as Klondike Bars, Choco Tacos, Creamsicles and Drumsticks; and candy such as M&M's, Reese's Peanut Butter Cups, Snickers and Skittles. They're in areas frequented by both patients and staff.
"Wow." says Janet Wojcicki, PhD, MPH, when told of the fare. A nutritionist and epidemiologist in the department of pediatrics at the University of California San Francisco (UCSF), she is the author of a 2013 opinion articlein the journal Acta Paediatrica calling for hospitals to jettison the bad food.
"I just feel very strongly that a health care environment should be at the forefront in terms of a healthy lifestyle," says Wojcicki. "If we are selling clearly unhealthy beverages and food items, we're sending a terrible message to the community and to those people that look up to health professionals for guidance in terms of lifestyle and nutrition."
Critics: pairing sugar with "healthy choices" doesn't cut it
Politicians and the food industry have tried to make a populist cause out of the right to buy sweetened beverages. After then-New York Mayor Michael Blooomberg attempted to ban super-sized fountain drinks, Sarah Palin famously drank from a Big Gulpduring a speech at a political action committee meeting, exclaiming "shoot, it's just pop."
The beverage lobby, for its part, counters concerns over sweetened soda by promoting calorie counts on the front of vending machines and saying that consumers can make informed choices. Critics say this approach is inconsistent with the larger goal of a hospital.
"You don't give a patient a choice to take a bad drug," says Mozaffarian. "You don't say 'here's something I know that will harm you and you can choose.'"
"We do know that environmental change is a very powerful way to help people make a better choice," says Rosenman. "Our mission is to improve the health and well-being of our patients, employees and community. It's important that the choices we have available be consistent with that message."
Wojcicki is less diplomatic.
"It's almost a ridiculous question," she says. "It's not like these items are illegal. You can still buy them. There has to be some type of public health message that these items are causing disease."
"Sugar-sweetened beverages are one food for which we have definitive evidence of harm," says Mozaffarian. "Multiple long-term observational studies have shown that people who drink sugar sweetened beverages have more weight gain and have higher risk of diabetes."
"Short term trials have shown that if you give sugary beverages, people eat more over the course of the day and you get rapid rises of blood glucose and insulin...So if you put all of that together, it's clear sugar-sweetened beverages cause obesity and diabetes and possibly heart disease although that's probably mediated through obesity and diabetes."
Taking away the option to buy Dr. Pepper doesn't come without work, says Rosenman. Health Partners overcame internal resistance through education and buy-in, however. "We've always taken a dedicated approach of trying to explain why we are making this move," she says, "and how important what we eat and drink is to our health, and really looking at the medical evidence."
"By really focusing on on the why, it brings people on board, because we're all working here in health care. We all want to do the right things for ourselves, for our families, and for our patients."
Hospitals once sold cigarettes, too
It's hard to believe hospitals once used to have cigarette machines, but they did. Fifty years ago clinicians balked at the idea of taking those out of hospitals, too. In early 1964 the Surgeon General's report declaring cigarettes a health hazard had been released, but it was only the start of the purge of the machines.
"I don't think we'll ever get to the point where we'll tell patients that they can't smoke," said Donald W. Bunn, assistant executive secretary of the Minnesota Hospital Association in a February 9, 1964 New York Times article. "Some patients are so dependent on cigarettes that this would deter their recovery."
Johns Hopkins researchers helped to write that report, and yet the hospital needed until 1976 to remove cigarette machines.
"Hospitals were the first places to ban smoking, says Dr. Robert Lustig, pediatric endocrinologist at UCSF, "and now everyone bans smoking for that reason... How can you promote good health when the second-most dangerous item is not just within reach, but actually beckoning you at every turn."
"I'm not going to tell you that sodas are worse than tobacco," says Lustig. "I'm not even going to tell you that sodas are as bad as tobacco. But I'm going to tell you that sodas are pretty bad."
"It's time to do this," he says. "It's time for the medical profession to lead."