Our Letter to the San Francisco Board of Supervisors

by Kelly Close and The diaTribe Foundation

Twitter Summary: San Francisco leads the way in urging moderation on the sugar front - our request on understanding that drinking soda (with lots of other things!) may contribute to #type2 risk but not #type1

San Francisco lawmakers recently voted in a unanimous decision to add a warning label to advertisements for sugar-sweetened beverages across the city that would read: “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.

It is commendable that our hometown of San Francisco is proactively fighting against diabetes and obesity, though we at The diaTribe Foundation wanted to highlight two major concerns we have with this warning label as currently written. Below, please see our letter to San Francisco Board of Directors representative Scott Wiener outlining these concerns.

Our Letter to San Francisco Board of Supervisors Representative Mr. Scott Wiener

Dear Supervisor Scott Wiener,

We are writing on behalf of The diaTribe Foundation, a 501(c)(3) non-profit dedicated to improving the lives of people with type 1 and type 2 diabetes, prediabetes, and obesity, and advocating for action. We represent those individuals affected by these diseases, acting as a patient voice amid an epidemic that will drive up health care costs, threaten care, and comprise the quality of life for millions. 

While our work is focused on a national level, we remain personally invested in the happenings within our local San Francisco and Bay Area communities. We are incredibly proud that the Bay Area has continually proven to be a national leader in the fight against diabetes and obesity, particularly through governmental policy initiatives. At present, we support San Francisco’s ordinance to add warning labels to advertisements for sugar sweetened beverages throughout the city. We truly congratulate the San Francisco Board of Supervisors for passing this ordinance through the unanimous 11-0 vote.

We do want to highlight two concerns with the ordinance’s warning label as currently written: (i) that it does not specify between type 1 and type 2 diabetes; and (ii) that it does not mention prediabetes. The proposed warning label states, “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” 

As it currently stands, this warning label is misleading from a scientific standpoint. An abundance of research supports the assertion that sugar-sweetened beverages increase the risk of type 2 diabetes, but not type 1 diabetes. Type 1 diabetes is an autoimmune disease affecting over one million people in the US. There is no literature supporting the association between sugar-sweetened beverage consumption and an increased risk of developing type 1 diabetes. Using the blanket term “diabetes” in this warning label incorrectly associates over a million of people in the US with increased sugar consumption and perpetuates public misconceptions about type 1 diabetes.

To our second point, as 86 million Americans are also living with prediabetes, we believe adding it to this warning would be invaluable for raising awareness of this condition. The CDC estimates that 15-30% of people with prediabetes will develop type 2 diabetes within five years; additionally, 90% of all those with prediabetes are unaware they have it. Prevention of type 2 diabetes should be a national priority, and awareness is the first step.

We do note that the risk of type 2 diabetes is influenced by a range of factors, including genetics and city infrastructure, in addition to lifestyle factors such as unhealthy eating choices and a lack of physical activity. Addressing sugar-sweetened beverages is an admirable step – and likely a necessary one – and moving forward we encourage the city of San Francisco to think beyond sugar-sweetened beverages in its efforts to prevent type 2 diabetes. Given the complexity of uncontrollable factors on an individual level that can contribute to type 2 diabetes risk, we believe that to effectively move the needle on type 2 diabetes, we need to think creatively about ways to address it from a variety of angles and perspectives.

In summary, we believe that the warning label should ideally read as follows: “WARNING: Drinking beverages with added sugar(s) contributes to obesity, prediabetes, type 2 diabetes, and tooth decay. This is a message from the City and County of San Francisco.”

Thank you for your service to the San Francisco community. We appreciate your time and look forward to continuing the conversation on our city’s plans for addressing these serious health matters. With our fingers on the pulse of the patient experience and the diabetes field, we hope to serve as a resource to you and to work together in San Francisco and beyond.

very best,

Kelly Close

Photo Credit: Creative Commons, JaGa