Setting: Communities & Government

This study estimates the cost-effectiveness of excluding sugar-sweetened beverages from eligible purchases in the Supplemental Nutrition Assistance Program and its potential impact on health equity.

Musicus AA, Barrett JL, McCulloch SM, Long MW, Ward ZJ, Cradock AL, Bleich SN, Gortmaker SL. Cost-effectiveness and health equity improvements from excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program. Am J Prev Med. 2025, In press. doi:10.1016/j.amepre.2025.108082. Epub 2025 Sep 8.

Abstract

Background

Although interventions to change nutrition policies, systems, and environments (PSE) for children are generally cost effective for preventing childhood obesity, existing evidence suggests that nutrition education curricula, without accompanying PSE changes, are more commonly implemented.

Introduction

Excluding sugar-sweetened beverages (SSBs) from eligible purchases in the Supplemental Nutrition Assistance Program (SNAP) has been proposed as a strategy to improve diet quality and health. This study estimates the cost-effectiveness of this policy and its potential impact on health equity.

Methods

The Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation and systematic review process was used in 2024 to estimate the potential impact of excluding SSBs from SNAP-eligible purchases over a ten-year period (2023-2032) for the U.S. population. Health outcomes related to excess weight, costs, and relative changes in obesity prevalence by income, race, and ethnicity group in 2032 were estimated.

Results

The policy is projected to be cost-saving, prevent 279,000 cases of obesity (95% UI: 149,000−446,000), and contribute 115,000 (95% UI: 60,100−187,000) quality-adjusted life years gained over ten years among SNAP participants. The policy could save an estimated $2.75 billion in healthcare costs related to excess weight over ten years, resulting in $3.35 in healthcare cost savings per dollar spent on implementation. Reductions in obesity prevalence were estimated to be 3.5 times greater among individuals with income ≤130% of the federal poverty level compared to the overall mean, and 3-3.5 times greater among non-Hispanic Black and Hispanic individuals compared to non-Hispanic white individuals.

Conclusions
Excluding SSBs from SNAP-eligible purchases could be a cost-saving strategy to improve health and health equity between income, racial, and ethnic groups. The U.S. Department of Agriculture could use pilot studies to test the real-world effects of excluding SSBs from SNAP.

Keywords
health equity; cost-effectiveness; Supplemental Nutrition Assistance Program; nutrition policy; sugar-sweetened beverages

Funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute under Award Number R01HL146625, the Centers for Disease Control and Prevention under Award Number U48DP006376, and The JPB Foundation. Dr. Musicus’ time on this work was supported by NIH grants T32CA057711 and T32HL098048. The content of this paper is solely the responsibility of the authors and does not necessarily represent the represent the official views of the Centers for Disease Control and Prevention or any of the other funders. The funders had no role in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication. Dr. Musicus is also affiliated with the Center for Science in the Public Interest (CSPI), but this work was completed entirely within her Harvard affiliation and does not reflect the views of CSPI. No financial disclosures were reported by the authors of this paper.

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