Waiting in line at a store checkout can be packed with temptations, with plenty of snacks and drinks to choose from. But almost none of these options are healthy, according to a new study.

Researchers at UC Davis found that 70% of the food and beverages at checkout in four cities in the state of California are unhealthy.

The checkout area of a store is the only place all customers must pass through. It’s known to trigger impulse purchases, with food manufacturers paying big money to place their products there.

In fact, a national survey found one-third of shoppers reported buying food or drinks found in the checkout area during their last visit to the grocery store.

In their study, the researchers found most food and drinks at checkout were candy (31%), sugar-sweetened beverages (11%), salty snacks (9%), and sweets (6%).

Healthy items were much less common. Water accounted for 3% of the options, followed by nuts and seeds (2%), fruits and vegetables (1%), legumes (0.1%), and milk (0.02%).

“The checkout lane has been designed this way through marketing agreements in which food and beverage companies pay stores to place their products — which are mostly unhealthy — at checkout,” Jennifer Falbe, associate professor with the Department of Human Ecology and lead author of the study, said in a statement.

Health risks

Children and adults in the US consume excessive amounts of added sugar, sodium, and ultra-processed foods. This can lead to significant health risks – from diabetes to heart disease.

Supermarket stores provide most of the food and drinks consumed in the country. This means the retail sector is very relevant for improving diet quality and influencing consumer decisions.

The researchers analyzed checkout lanes in over 100 stores in Davis, Sacramento, Oakland, and Berkeley. Stores included supermarkets, grocery stores, specialty stores, drugstores, dollar stores, and mass merchandisers. They did their analysis in February 2021 before a law in Berkeley asked stores to offer nutritious options at the checkout.

Berkeley was the first city in the country to implement a healthy checkout policy. The policy is in line with federal dietary guidelines that ask to eat more nutrient-dense foods, such as fruits, and cut back on sodium and added sugars.

“Shoppers can still get candy from the candy aisle, but it won’t be forced on them at checkout,” Falbe said.

In the study, Berkeley’s policy served as a reference point for assessing the products available at checkouts. The proportion of food and drinks aligning with healthy standards was higher in chain specialty food stores and chain supermarkets. Meanwhile, dollar store chains had the lowest adherence to healthy standards.

The researchers hope these findings can be used to further improve the food environment for people across all neighborhoods and store types.

“There’s an opportunity here for checkouts to offer more choice by expanding access to healthier options,” Falbe said in a statement. “Currently, consumers lack choices at the checkout.”

The study was published in the journal Current Developments in Nutrition.