At the end of a grocery run, shoppers in Berkeley are now more likely to face fruits and nuts than candy and soda in the checkout lane. A first-of-its-kind city ordinance that took effect in 2021 requires large grocery stores and other retailers to replace sugary drinks and sweets at checkout with healthier options like water, nuts, seeds and fruit.

A new UC Davis study, published in the American Journal of Public Health, shows the Berkeley policy is having a measurable impact: Added sugars in food and drink products at checkout dropped by 70% in the first year after it was implemented.

The study also finds a 53% reduction in sodium in beverages, 41% and 27% decreases in saturated fat and calories in foods and beverages, and a 47% increase in fiber per serving in foods and beverages.

“The big picture is, healthy checkout policies work by making the healthier choice the easy choice,” said Jennifer Falbe, associate professor with the Department of Human Ecology and senior author of the study. “Over a third of people buy a food or beverage product from checkout in any given shopping trip, so this may be affecting a lot of people and potentially what they purchase and eat.”

Sweet reduction

These nutritional improvements matter because high intake of added sugars, sodium and saturated fats, as well as low intake of fiber, is linked to chronic diseases like diabetes, heart disease, cancer and stroke.

To measure the policy’s impact, researchers analyzed the nutritional content of foods and drinks available at checkout before and after the ordinance went into effect. Allie Reimold, lead author of the study and a postdoctoral scholar with the Department of Human Ecology, said that, on average, the amount of added sugar per serving of foods and beverages at checkout dropped from 11 grams before the ordinance to roughly 3 grams afterward.

The impact of the policy is even more obvious when looking at just beverages at checkout, which went from roughly 23 grams of added sugar per serving before the policy to under 7 grams after the policy – a 16 gram difference, or one-third of the daily recommended limit.

“Around four grams of sugar is in a teaspoon. Before the policy, there were six teaspoons of added sugar, on average, per serving of beverages at checkout,” said Reimold. “That's a lot of added sugar, and most people don’t realize they’re consuming that much.”

Checkout comparisons

Berkeley’s policy was designed to address the deliberate placement of products like soda and candy in high-traffic checkout lanes, potentially making the end of a shopping trip less stressful for shoppers, especially parents shopping with children. A previous study published last year by Falbe’s team found that the percentage of healthy foods and beverages at checkout more than doubled after the policy was implemented, increasing from 29% to 62%.

Building on this earlier work, the researchers compared stores in Berkeley to those in Oakland, Davis and Sacramento, cities without a healthy checkout policy but with similar store types and community demographics.

Data collection began before the policy went into effect, when teams of researchers took photos of checkout lanes in about 100 stores in the region. They continued collecting data annually after the policy was implemented, eventually gathering nutritional information on more than 70,000 products that were available for sale in checkout lanes.

“Because of the intensive data collection that we conducted, we have a rich dataset that shows, definitively, that this policy is being implemented relatively well,” Reimold said.

With the one-year results in hand, the researchers plan to study long-term trends, including how stores maintain the policy and how shoppers respond. That includes tracking sales data and talking with retailers about what helped or challenged their ability to implement the ordinance.

Unwrapping what’s next

Falbe said the team is also looking more closely at how the policy overlaps with growing efforts to limit ultra-processed foods. In California, the governor recently signed an executive order aimed at reducing the availability of ultra-processed foods. Since many common checkout items like candy, salty snacks and sugary drinks that are no longer allowed at checkout in Berkeley often fall into the ultra-processed category, the researchers say Berkeley’s ordinance could help support broader moves to cut back on these types of products.

Berkeley’s ordinance sets nutritional standards, requiring checkout products to fall into specific food groups (including fruits, vegetables, nuts, whole grains, gum) and contain no more than five grams of added sugars and 200 milligrams of sodium per serving. Falbe said their research is showing positive effects, which could encourage other cities to pursue similar healthy checkout policies.

“There are different nutritional standards that could be used for a policy like this, but what we found is that Berkeley's standards are a good starting point,” Falbe explained. “They are resulting in meaningful changes to checkout that were intended. Berkeley's policy is a model for other cities that want to accomplish similar results.”

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01DK135099) and the Bloomberg Philanthropies’ Food Policy Program (2020–85774; https://www.bloomberg.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Bloomberg Philanthropies.