In March 2021, Berkeley, California 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 wait in line.

A new study led by researchers at Boston University School of Public Health (BUSPH) and the University of California, 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.

Compliance Made the Difference

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 (though not after enforcement), but so did sales of 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 sugary items, while drug stores, which complied the least, did not see 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.

“Checkout lanes are intentionally designed to draw shoppers’ attention to high added-sugar snacks,” said Dr. Justin White, associate professor of health law, policy and management at BUSPH. “Our findings suggest healthy checkout policies can help reduce impulsive purchases and encourage healthier snack choices, but active enforcement is critical.”

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 at UC Davis. That 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.

Tracking Sales Before and After Enforcement

For the analysis, the team examined 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, capturing sales before and after the HCO was implemented and before it became enforceable on January 1, 2022.

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

“The ordinance does not prohibit stores from relocating sugary drinks and snacks to other areas,” said Dr. White. “Stores should consider implementing more comprehensive restrictions to achieve maximum public health benefit.”

“No single policy alone can address the problems with our food system,” said Dr. Falbe. “However, expanding healthy checkout policies to cover other prime locations and pairing this 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, though 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 said. “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 Washington University in St. Louis, the University of Illinois Chicago School of Public Health, and Stanford University School of Medicine, and was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R01DK135099.

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Journal: The Lancet Public Health
DOI: 10.1016/S2468-2667(26)00169-6
Article Title: Effects of a healthy checkout ordinance on the sale of soft drinks and confectionery in Berkeley, CA, USA: a quasi-experimental study