Cost-effectiveness and health equity improvements from excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program

Authors

Aviva A. Musicus, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: aam231@mail.harvard.edu.
Jessica L. Barrett, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Stephanie McCulloch, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Michael W. Long, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC.
Zachary J. Ward, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Angie L. Cradock, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Sara N. Bleich, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Steven L. Gortmaker, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Document Type

Journal Article

Publication Date

9-8-2025

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2025.108082

Keywords

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

Abstract

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.

APA Citation

Musicus, Aviva A.; Barrett, Jessica L.; McCulloch, Stephanie; Long, Michael W.; Ward, Zachary J.; Cradock, Angie L.; Bleich, Sara N.; and Gortmaker, Steven L., "Cost-effectiveness and health equity improvements from excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program" (2025). GW Authored Works. Paper 7979.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7979

Department

Prevention and Community Health