Healthy checkout ordinance linked to lower soda and candy sales

A new study found that a healthy checkout ordinance implemented in Berkeley, Calif. supermarkets, drug stores, and mass-market retailers in 2021 was linked to notable decreases in soda sales overall and small-package candy in supermarkets, but greater enforcement of such policies is essential for sustained and meaningful public health benefit.

In March 2021, Berkeley, Calif. became the first city in the world to ban the display of sugary beverages and snacks in store checkout lanes, where candy, chocolate, and soda are commonly placed to encourage impulse buying while shoppers are in line.

A new study led by researchers at Boston University School of Public Health (BUSPH) and the University of California, Davis (UC Davis) examined the effects of this healthy checkout ordinance (HCO) on shoppers' purchasing decisions and found that the policy was linked to a decrease in soda sales and small-package candy in supermarkets, but not total candy sales. 

Published in The Lancet Public Health, the study assessed candy and soda sales in supermarkets, drug stores, and mass-market retailers in Berkeley, as well as three comparison cities in California, after the HCO was implemented in 2021 and then became enforceable in 2022. Changes in sales varied by product and store type: soda sales decreased substantially after the HCO was implemented and enforced, while sales of small-packaged candy decreased significantly in supermarkets after the HCO was enforced. Overall candy sales increased moderately after the policy was implemented (but not after enforcement), but so did sales in healthy, lower-sugar items such as snack-sized nuts and seeds. Supermarkets, which complied the most with the HCO, saw the greatest declines in sales of these sugary items, while drug stores, which complied the least, did not have reduced candy or soda sales.

Overconsumption of candy and sugar-sweetened beverages can lead to a range of health issues, including type 2 diabetes, heart disease, and tooth decay. The 2025-2030 federal Dietary Guidelines for Americans recommend that children under 11 refrain from consuming any added sugar, yet nationwide, 6 in 10 youth drank a sugar-sweetened beverage on a given day, according to the Centers for Disease Control and Prevention.

As other cities in the US and other countries consider and begin to implement similar HCO policies, this new insight can inform checkout standards in other settings.

"Through bright lighting, colorful packaging, and eye-level placement, checkout lanes are intentionally designed to draw shoppers' attention to snacks and beverages with high added sugar," says study co-lead author Dr. Justin White, associate professor of health law, policy & management at BUSPH, who led the analysis with Dr. Ziyue Xu, research scientist in the Department of Health Law, Policy & Management at BUSPH. "Our findings suggest that healthy checkout policies can help reduce impulsive purchases and even encourage healthier snack choices, but it is critical for cities to actively enforce these policies if they aim to see meaningful and sustained decreases in sugary product sales." 

The study builds upon prior assessments of store checkouts in Berkeley and nearby California cities, led by Dr. Jennifer Falbe, senior and corresponding author of The Lancet Public Health study and an associate professor of nutrition and human development in the Department of Human Ecology at the College of Agricultural and Environmental Sciences at UC Davis. The previous work showed that candy and sugar-sweetened beverages were among the most common items found in checkout aisles, and that the amount of added sugar in checkout foods and beverages decreased by 70 percent in the first year after the HCO was implemented. The latest findings reveal that this policy also changed purchasing behavior. 

For the analysis, the team analyzed retail scanner data in 71 stores in Berkeley and three nearby cities for comparison (Davis, Oakland, and Sacramento), to assess stores' quarterly sales of candy and soda (by volume), as well as nuts, seeds, and bottled water between March 2019 and December 2023-to capture sales before and after the HCO was implemented, before becoming enforceable on January 1, 2022. 

Examining candy and soda sales by package size enabled the researchers to determine whether the HCO achieved its intended goal of reducing purchases of snack-sized items that are most typically located in checkout aisles. The decline in soda sales and the significant drop in small-package candy sales in supermarkets-which were among the store types with the highest compliance-showed that the HCO likely had some effect on purchasing behavior but, by design, could not capture other placement or promotional changes that stores may have made to boost sales of these products. 

"The healthy checkout ordinance does not prohibit stores from simply relocating sugary drinks and snacks to other areas of the store, or including them in seasonal displays," says Dr. White, emphasizing that stores should consider implementing more comprehensive restrictions on sugary products to decrease total candy sales and achieve maximum public health benefit.

"No single policy alone can address the problems with our food system," says Dr. Falbe. "However, expanding healthy checkout policies to cover other prime locations and pairing this policy with evidence-based strategies like mandatory front-of-package labeling, sweetened-beverage excise taxes, and subsidies for healthy foods, could improve diet quality."

The US Food and Drug Administration is already considering a mandatory front-of-package labeling rule, but the final label design has yet to be determined. "If the FDA moves forward with a well-designed front-of-package label, they could make it easier to implement healthy-product-placement policies," Dr. Falbe says. "Stores and city inspectors could use 'high in added sugar' or 'high in sodium' labels, to spot products that should not be placed in prime locations like checkout lanes."

The study was coauthored by researchers at the Andrew M. and Jane M. Bursky School of Public Health at Washington University in St. Louis, the University of Illinois Chicago School of Public Health, and Stanford University School of Medicine. The study was supported by the National Institute Of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R01DK135099.