Berkeley improves healthfulness of store checkouts by 63% with new policy

09 Aug 2024 --- One year after implementing a “healthy checkout ordinance” at stores in Berkeley, California (US), the share of compliant products in store checkouts increased by 63% compared to other cities. The healthy checkout ordinance allows nonfood products, unsweetened beverages and foods with a maximum of 5 g of added sugar and less than 200 mg of sodium per serving — sugar-free gum and mints, fruits, vegetables, nuts, seeds, legumes, yogurt or cheese and whole grains. 

In March 2021, Berkeley became “the world’s first city” to implement a healthy checkout policy. It applies to all stores with over 2,500 ft2 (232 m2) of floor space selling at least 25 linear feet of food. 

Research by the University of California (UC) Davis, US, concludes that 83% of products stocked at checkout were compliant a year after the policy’s implementation, compared to 53% a year earlier. Moreover, the share of healthy foods and beverages increased by 125%, growing from 29% to 62%.

“We see quite a dramatic improvement in the healthfulness of foods and beverages in Berkeley store checkouts,” says Jennifer Falbe, associate professor of nutrition and human development in the UC Davis Department of Human Ecology and lead author of the study. 

“Before the policy, the majority — about 70% of food and beverage products at checkout — were unhealthy, and now that’s been cut in half,” adds Falbe. “Stores replaced sugary drinks, candy and other sweets with unsweetened drinks, healthy foods like nuts, seeds and fruits and nonfood items.”

Healthier food environment 
Berkeley’s checkout policy applies to all food and beverages in all checkout areas of the city’s large food stores, such as supermarkets, mass merchandisers, drugstores and large grocery, dollar and convenience stores.

Typically, chain stores stock candy and soda at checkout. Falbe explains this is due to marketing contracts where ultra-processed food and beverage companies pay stores for premium placement. 

“Many of us think of the grocery store as a neutral environment and don’t realize how our decisions may be influenced, including where products are placed.”

The researchers analyzed 76,258 product facings, including nutritional information, at the checkout areas of 23 stores in Berkeley and 75 stores in three comparison cities in California — Davis, Oakland and Sacramento. They determined the products’ compliance with the policy and their category. 

The UK and Perris, California, are also implementing legislation to set nutritional standards for store checkouts.The study, published in JAMA Network Open, compared product data one month before the policy’s implementation with product data one year later. The share of unhealthy foods at checkout decreased significantly, from 30% to 6% for candy, 11% to 5% for sugar-sweetened beverages and other sweets from 7% to 3%. 

Meanwhile, the share of unsweetened beverages at store checkout increased from 4% to 19%, and the share of healthy foods grew from 6% to 20%. 

Compared to the Berkeley stores, the checkouts at stores in comparison cities remained the same over time. 

Food store improvements 
The researchers found the highest compliance with the policy in chain and independent supermarkets, chain mass merchandisers and chain specialty food types. 

The study did not include convenience stores in its sample. Most of these stores are too small to be subject to the law. The one store that was large enough was left out because early discussions had suggested that convenience stores would not be subject to the policy. 

The researchers note that future research is needed to explain the relatively high compliance with Berkeley’s ordinance. At the same time, they explain that earlier research suggests compliance may be higher among chain retailers — which comprised 74% of the city’s sample — when a policy is simple, technical assistance is provided and retailers are accustomed to regulation. 

“These improvements in the healthfulness of Berkeley store checkouts happened just one year after the policy took effect and just one month after the policy became enforceable. With more time and technical assistance from the city, store checkouts may improve even further,” underscores Falbe.

Meanwhile, research supports the importance of the food environment in the healthiness of product purchases. For example, scientists found that absorbing nature leads to healthier food choices. 

Organizations also call for a healthier food environment. The WHO unveiled an action guide for healthier foods at sports events. At the same time, the EU Food Policy Coalition calls for minimum criteria for public canteens as part of its “Buy Better Food” campaign to improve public health and access to nutrition. 

Additionally, organizations urge F&B manufacturers to develop healthier food portfolios. For example, the Access to Nutrition Initiative and Planet Tracker published a report that builds a business case for investing in nutrition. They identified higher profitability and valuation for companies with healthier food portfolios than their “unhealthy peers.” 

By Jolanda van Hal