state to date it has not been successful in this regard. that's the end of our report. we'll be happy to answer any questions. >> any questions? thank you. the next speaker is robert vargas with ucfs with the policy program. they have advised on the health impacts and he's here to respond to the report. >> good morning. thanks for having the budget and legislative office prepare this report. we are happy to be a part of gathering this data and helping it to be more accessible to the rest of the folks in the city. we really

think it's important that folks are wear of the health impacts of this particular product. we are also very interested in partnering with the city and the university to inform policy decisions and public health approaches and take a look at the most current research and we believe that we have some highly qualified researchers at our university to help with that information. i think this is a really important report for presenting what is a very difficult issue without having

all of this information is difficult to understand. this information is really helpful in doing that. also in addition to what's being prepared here there is a number of disparity. what often gets lost in the conversation is the fact that there is tremendous disparity with regard who is tools to -- to who is impacted. for example, if we look at rates of over weight or obesity in san francisco, the african american community is higher impacted at 21 percent

in the community at being overweight. multiracial folks are impacted at 68.2 percent, latinos and pacific islanders. it's important to take into consideration that more than one community is more impacted than others. the hospital rates by neighborhoods we'll see -- where i live, that is the bayview. for hospitalizations per 10,000 people, 18 and over, if we look at age adjusted hospital rates due to diabetes, it's 29.7. in the 94102, it's

22 .2 and you have communities where the numbers are much lower like 4.3, 5.5 and 6.3, etc. we are looking at higher numbers. did you have a question? >> i was scratching my head but not in confusion. i was thinking about my district about 94-1-12. >> 10.8. about mid-range. most recently we had an opportunity to take a look at some data that shows excels ior was at the higher end with regard to consumption given the latest data. those rates may have gone up because the data is a couple years old. all of this said

which is important information, we appreciate the budget and legislative analyst office preparing this report. >> can you tell me the data for the fillmore district, 94-1-15. >> that's 14.8 hospitalizations per 10,000 population per year. on the higher end i would say, all of this data is available at sf hip.org, san francisco health improvement partnerships. this is data that's been prepared and presented by san francisco hospital counsel and sf hip is a sponsorship of counsel and ucfs and other participants. any other questions? thank you

for your time. >> i had a question, from what miss guma and mr. smith looked at, are there other questions that we need to answer to help policy making? >> that's a great question. as i mentioned this is a huge you -- issue and so some things that i know i have heard from other scientist who have been in inquiring from me with regards to impact of sugary drinks, folks have brought to my attention with impacts on oral health specifically with children in terms of oral health. we have tremendous oral health disparity in san francisco. we have a lack of access to dentistry especially those that will take government

subsidized dental insurance. that may change. i know the center for health serves the portola and bayview and there is limited access there. we also know that immigrant populations in particular, asian and latino immigrant children also suffer much higher rates of dental carries or cavities. so being able to quantified the impact of sugar ary drinks on children's oral health will help us get a better picture of broad impact of sugary drinks. the research shows us that sugary drinks are one of the greatest contributors to children's cavities what we call dental carries. >> thank you very much. i

skipped over christina gupta who is senior health planner from the department of public health. >> thank you supervisors. so, i just wanted to give you a little bit of background this afternoon about why the public health field has been looking at sugary drinks as an issue. i wanted to start talking about what happens to sugar when it's in our bodies. sugar suppresses our bodies ability to consume fat. our body is the first one -- do you have an extra copy of the pregnancy -- presentation that you are making?

>> i will make copies. >> so it suppresses our ability to burn fat. so when we eat sugar in high quantities our body priorities first burning the sugar before it starts burning the food that you might consume with that drink. so let's say you have a frappuccino with breakfast and a bagel. your body is not going to start working on that other food. if you haven't fully processed that by the time you have your next sugary item. that other food may not get processed and turns into fat in your body. next, the way that sugar is metabolized is different than natural sugars. it's often converted to fat in your liver. when it's consumed

m large quantities and quickly it's metabolized by liver and converted to fat. as we heard that significant obesity and chronic conditions. it also alters our hunger response. so we think that we are starving when in fact we are not. that has to do with the hormone called leptin. it resides in your fat cells and signals to your brain when you are full. and people can develop leptin resistance much like you can develop insulin resistance if you are diabetic. what happens then is your brain does not get the message from the leptin hormone that you should stop eating that you are full. you just continue to feel hungry and you want to eat more. i personally have experienced this. lastly sugar alters the reward center in our brains.

similar to addictive substances like alcohol, cocaine and nicotine, sugar downloads the similar receptors in your brain and we develop greater tolerance of those substances and in the case of sugar we crave more sugar and it bgs a -- becomes a vicious cycle. i think it's fortunate understand -- important to understand that. when you take a look at the food system, sugar is really all over our food system. and as was mentioned previously about half of those sugars come from beverages. when you take a look at the

beverages, soda contributes to the added sugar in our diets. when you -- calories from beverages that we drink often don't displace the calories that you might eat. so you will add those calories next to that burger and fries and again it has to do with your if physiological response where a drink may make you feel hungry. and from an environmental perspective when you look at the setting we are living in when mcdonald's introduced it's first coke was 7 ounces and now you can go to 7-eleven and get 128-ounce gulp. you can also

take a look at pricing and the prices for healthy food and fruits and vegetables have south -- courting -- according to the consumer price index and coupled with the fact that your body craves it, it's something of an important dynamic that's going on here. we can see that over the decades as soda consumption has increased so has childhood over weight. you can see that correlation here. we are really pleased to see this is newer data from the california for public health advocacy showing consumption among adolescence and we have seen a decrease by younger children. that's positive. i think some of the education efforts we have taken have made greater impact.

however we have not seen that among older children. that is a concern that we have heard earlier. if you are over weight as a young person, there is a 63 percent chance that you are going to be overweight as an adult. >> what is the percent? 63 percent. >> yes. looking at local data, there is this slide that talks a little bit about the disparities in san francisco that roberto spoke to. here we are looking at ninth graders, african americans and latinos. we see this translated down to san francisco. it's not just national data. we see this also among our adults and with the latino and african american

populations that consume more sugary drinks. >> can i ask about adolescence. it's my understanding that a ucla study shows slight decrease in younger children but in adolescence there has been an increase in energy drinks and marketing are tied in with a lot of the types of sugary beverages. can you touch a little bit on that? >> yes. i think it's part of the environment that children are in and as an adolescence you are going to have more independence and more pocket change. the industry does a lot of marketing towards young people and whereas in the younger age groups parents have more control of what their children drink. i think that contributes. the whole series of pieces that contribute to children drinking more sugary

drinks. does that answer your question? >> yes. >> so, taking a look at soda expenditures it tracks pretty closely to what we see with over weight and diabetes. it's more with people of color and the diabetes rate you see that same pattern emerging. it speaks to the fact that we have significant health inequities and desperate health outcomes. lastly, a couple of points of impacts on sugary drinks. there is a recommendation -- >> can i go back to the diabetes hospitalization map. roberto vargas pointed out area code 94124 on the bottom side of the further eastern zip code of the city and supervisor

cohen raised concern about that, she asked about the fillmore district. it's areas with heavily low in come population and african americans and people of color and heavily on the eastern neighborhoods in the city and a little bit up there in china down toun and tenderloin and other spots. >> that is correct. so in terms of the a sugar that we are consuming, average americans are consuming about 22 teaspoons a day and recommended that men not have more than 9 teaspoons and women and children 3. >> for a 20 ounce. >> i was looking at the can assuming that people are still drinking the cans and not the

20 ounceers. even the small size would blow that recommendation out for the day. the graphic just represents that and roberto was get to go that as well in terms of the fact that sugar drinks really impact our entire system, every part of our body. we don't have a lot of information on the impact on oral health . we know it impacts oral health. children under the age of one have a tremendous increase in dental carries. the children are among the heaviest consumers of sugary drinks. that becomes an issue because the phosphorous can lead to

calcium leaching from the bones and this can replace healthier drinks from homes such as milk. it used to be twice a day and now soda is consumed twice as much. this is a picture of a liver. a normal liver and a fatty liver. what we understand from our partners at ucsf is that not alcohol liver disease is accounting for 20 percent of liver transplant per day that is something that didn't happen in the past. >> that's non-alcoholic liver disease? >> non-alcoholic fatty liver disease. and then lastly to

what we've been speak together issue of over weight and obesity. there are many other health impacts. guma referred to others. these are ones that we see from tremendous impacts with sugary drinks. i will take questions. >> that is a really helpful presentation. you mentioned a statistic that we talked about before that a 12 ounce can of soda has 9 teaspoons of sugar and 17 ounces and a 20 ounces bottle. you showed a slide the biggest of the big gulps. so for example the teen gulp at

7-eleven, i hadn't heard of that one. 128 ounces. that would put us at over 100 teaspoons depending on how much ice the person would put in there. it could be more than 100 teaspoons of sugar in one beverage. even if you go down to the king size burger king, that would be 45 teaspoons of sugar? >> yes. i think that's about right. >> i think if you would ask any person particularly a parent, but i think for example a parent or anyone, would you sit down with a bag of sugar and eat it

whether it's 15 or 20 or 40 or maybe 100 teaspoons of sugar, i think most people would find that to be pretty compulsive and not to mention in incredibly unhealthy. it's such a useful sight in terms of the sizes and the sugar and not because of the reaction some of us might have but it shows why sugary beverages are so different even in sugary foods. sometimes what we hear from the beverage industry why are you posting a tax on sugary beverages? why not donuts and cookies. we know that eating a cookie or cake, it eventually shuts off your appetite. but

just the shear amount of sugar rushing your system quickly in quantities that it's going to be very hard to get from even a cake or a cookie, it's really extraordinary and it's why sugary beverages are a health detriment that is very different and above and beyond the health detriment from sugary foods. i think this chart showing the difference sizes is very instructive. going back to the 1960s and 70s just the sizes of the sugary drink containers, the size was so much smaller and it's gotten bigger and bigger. in richmond one of the biggest oh opponents of the sugar and

beverages tax was the movie theatres. if you look at the size that movie theatres are selling is pretty extraordinary. i'm glad you put this chart in because it's instructive. you may want to consider modifying this chart to show what the range of teaspoons of sugar is for x size of drinks. >> thank you supervisor, i think you really hit the nail on the head with your comments. >> any other questions, colleagues? >> i think the mother jones magazine graphic should be an educational piece used everywhere. even just the names of the drinks humongous to the big drinks are really outrageous. thank you. seeing no other questions, thank you so much, miss gupta. dr. from

ucsf professor of health policy. thank you, dr. smith. >> thank you. i come from a background of having spent over 25 years in my career doing research on public health prevention. i recently spent three years working for the un commercial term nants of health to prevent and health strategies to one of the most effective strategies for affecting the consumable products that are harmful to health that being sugary beverages and doing studies in national institutes of health.

when i speak about what we don't know about sugary beverages and taxation. i spent a quarter of my lifeworking in this area of research. i want to first speak to some of that, i think budget and legislative analyst report, i was able to read it. i think it's a wonderful piece of work. the ability to bring national and local data to bear is great. i want to speak to some things that are not in the report and that as your representative said, it's a very conservative report. and there are a number of aspects of what we know in the scientific community and the public health communities that could be brought to bear in this discussion. the first one is the larger evidence around taxation. someone mentioned that mexico had just passed a soda tax. i want you all to know that i'm doing

research on this now with a law professor at georgetown law school. 14 countries around the globe have national soda taxation regimes and many more are currently deliberating. so the city of san francisco is in very good company with most of the nord icic countries and increasing developing countries are using taxation as a strategy to protect public health. the body of evidence which you are proposing to do is vast and extensive. we know about, in the world of science we talk about robust evidence. that means evidence that applies in numerous areas and points to the same conclusions. the evidence around taxation is that it works in all areas from

alcohol to tobacco to sugar sweet and beverages. the policy that you are considering here and especially the threshold of a $0.02 per ounce tax is highly valid, it has tremendous support in a large body quasi experimental epideem logical research. at the level of medical science, i want to hit on a few words that were not hit on as it possibly could have been from the report of the budget and legislative analyst office. the first has to do with what we are learning and this is fairly new research but very much a growing consensus among scientist especially those funding by national health, the world

health organization, the research that doesn't have a particular agenda behind it but it's neutral and objective research about the effects of sugar and added sugar and particularly sugary beverages on human health. one of the newer set of findings, with tremendous amount of scientific consensus is the impact of heavy fructose consumption of sugar. fructose is one form of sugar but a very common form of sugar. it can have anywhere from 45-90 percent from when laboratories produce it. fructose is metabolized in the liver. that is where the difficulties start. the fact that fructose is metabolized in

the liver. as christina gets from the health department alluded to. when it is metabolized in the liver, if it is in large quantities and in a very quick dose such as the kind of heavy dose you might get from having a sugar sweet and beverage on an empty stomach, the liver is bombarded by a large quantity of fructose and this particular substance within the liver is known to be toxin. it's what we call a hepatic toxin, a substance toxic to the liver like alcohol. this is when we see non-alcoholic liver cirrhosis, non-alcoholic fatty liver disease and what we used to see as belly is now sugar belly. for people who don't have