





































ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. 
 

MAKING A DENT IN THE 

OBESITY EQUATION VIA 

COUPLING SUGAR- 

SWEETENED BEVERAGE 

TAXES WITH FRUIT AND 

VEGETABLE SUBSIDIES 
 

SARAH PFREUNDSCHUH 

 

✵ ABSTRACT 
Obesity rates continue to rise in children 

and adults alike in the United States and represent 

a significant threat to public health and economic 

well-being. Many factors have contributed to the 

obesity equation, including the widespread availa-

bility and appeal of ultra-processed food and drink. 

Sugar-sweetened beverages (SSBs) represent one 

such drink, as a critical examination of the available 

evidence reveals a clear link between their con-

sumption and increased risks of obesity and related 

conditions such as type 2 diabetes. Taxing SSB pur-

chases therefore presents a potentially valuable 

means of making a dent in the contribution of one 

key risk factor to the obesity equation, though the 

beverage industry has fought against the enactment 

of these taxes and has instead promoted a generally 

unclear public health stance on SSBs. This paper ex-

plores existing SSB excise taxes that have been im-

plemented in recent years, focusing especially on 

Philadelphia’s tax as a case study for examining the 

behavioral changes associated with SSB taxes and 

the management of SSB tax revenue. It then sug-

gests that SSB tax revenue be directly funneled into 

the subsidization of fruits and vegetables to maxim-

ize the obesity-fighting potential of these relatively 

novel excise taxes.  

 

1 INTRODUCTION 
Since the late 1970s, obesity has been 

steadily rising in the United States (Office of the Sur-

geon General, 2010; Dixon, 2020), with its preva-

lence reaching 42.4% among adults ages 20 and 

over from 2017-2018 (CDC3, 2022). Even amongst 

American children, 1 in 5 were obese as of 2018 

(CDC, 2022). Obesity is a significant risk factor for a 

multitude of chronic health conditions, including 

type 2 diabetes, coronary heart disease, hyperten-

sion, high LDL cholesterol, low HDL cholesterol, 

dyslipidemia, gallbladder disease, and osteoarthri-

tis (CDC1, 2022; Must et al., 1999). These chronic 

health conditions reduce the quality of life of mil-

lions of Americans and present an enormous eco-

nomic burden, amounting to nearly $173 billion an-

nually in obesity-related medical costs (Ward et. al., 

2021). Additional economic costs stem from the lost 

productivity associated with overweight and obese 

status (CDC1, 2022), though such costs pale in com-

parison to the medical costs of obesity. 

Given the enormous cost of obesity to both 

the economic vitality and public health of America, 

addressing its complex causes is of paramount im-

portance. Factors such as increasingly sedentary 

jobs and lifestyles, low levels of intentional physical 

activity, and the wide availability and popularity of 

calorie-dense, ultra-processed foods have been 

linked most consistently to obesity (Hruby & Hu, 

2015; Dixon, 2020). Nonetheless, numerous other 

more biologically and socially complex factors —

such as exposure to obesogenic endocrine-disrupt-

ing chemicals, sleep quantity and quality, psycho-

logical conditions, poverty, poor education, lack of 

access to healthy food, and genetics — also play a 

role (Hruby & Hu, 2015; Dixon, 2020). This over-

whelming number of factors that cumulatively con-

tribute to the overall risk and prevalence of obesity, 

forming the so-called “obesity equation,” as I call it, 

necessitates that the issue be addressed from mul-

tiple angles. Figure 1 depicts the multifactorial na-

ture of obesity. 

 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

  

FIGURE 1: Several diverse factors that contribute to the “obesity equation”.  

 

In the sections of this exploratory synthesis 

paper that follow, I address one such angle whereby 

the obesity problem can be intercepted: the con-

sumption of sugar-sweetened beverages (SSBs). 

First, I delineate the evidence linking consumption 

of SSBs to obesity and related chronic conditions. I 

subsequently discuss in the context of SSBs the use 

of excise taxes, or taxes waged at the distributor-

end on specific goods and activities that tend to dis-

courage purchases by resulting in higher prices at 

the consumer-end (Chaloupka et al., 2019), as a tac-

tic to help make a dent in the obesity equation in the 

United States. Laced throughout is a discussion of 

the soda industry’s role in promoting increased SSB 

consumption and opposing public health initiatives 

to implement SSB excise taxes, despite strong evi-

dence for the negative health effects of SSBs. Fi-

nally, I propose that revenue from existing SSB ex-

cise taxes such as Philadelphia’s be funneled into in-

itiatives that further fight obesity to maximize their 

public health efficacy and I highlight evidence of 

fruit and vegetable subsidization as one potentially 

suitable initiative. 

 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

2 SUGAR-SWEETENED BEVERAGES, 

OBESITY, AND RELATED CHRONIC DIS-

EASE: THE EVIDENCE 
Sugar-sweetened beverages include any 

beverage sweetened with a form of added sugar, 

such as sucrose or high-fructose corn syrup, includ-

ing regular soda, sports drinks, and fruit drinks 

(CDC, 2022). While SSBs represent only one of 

many determinants of obesity, prospective cohort 

studies have consistently linked increased con-

sumption of SSBs to weight gain and long-term risk 

of obesity and related conditions like type 2 diabe-

tes (Hu, 2013; Malik et al., 2013). Increases in SSB 

consumption in recent decades have also directly 

paralleled increases in obesity (Hu & Malik, 2010), 

further suggesting a likely link between the two 

trends. Though some trials are limited by small sam-

ple sizes and relatively short intervention periods, a 

handful of clinical trials have solidified a likely causal 

relationship between SSBs and obesity. These stud-

ies demonstrate that in children, reducing SSB in-

take slows weight gain, and in adults, SSB consump-

tion can promote weight gain (Wolff and Dansinger, 

2008; de Ruyter et al., 2012). Moreover, studies 

showing no such apparent SSB-obesity connection 

should be analyzed critically. For instance, in a clini-

cal trial of 47 overweight subjects randomly as-

signed to drink 1L per day of regular soda, semi-

skim milk with an equivalent number of calories to 

regular soda, aspartame-sweetened soda, or water 

for 6 months, Maersk et al. (2012) found no signifi-

cant differences in the changes in body weight and 

fat mass between groups over a 6-month period. 

On a smaller scale, however, the group consuming 

regular soda had significantly higher increases in 

liver fat mass, visceral fat mass, muscle fat mass, 

plasma triglycerides, and total cholesterol com-

pared to the other 3 groups, indicating that SSBs im-

pair cardiometabolic health with uncertain implica-

tions on long-term health, including body weight. 

The most common mechanism to explain 

the link between SSBs and obesity is that the con-

sumption of liquid calories does not yield propor-

tional caloric reductions in solid food intake (Malik, 

2010), thus leading to excess calorie intake that pro-

motes weight gain. Lending support to this theory, 

DiMeglio and Mattes (2000) performed a crossover 

study in 15 normal-weight adults and found that 4 

weeks of dietary supplementation with 450 calories 

of regular soda led to an increase in total caloric 

consumption and BMI, yet no such changes were 

found when diets were supplemented with 450 cal-

ories of jellybeans. Moreover, research has shown 

that the oversized portions of sugary drinks sold at 

many fast food chains and other outlets such as 

movie theaters not only cause people to consume 

more than they would from a smaller portion even if 

they do not finish the entire beverage, but these 

larger portion sizes also lead individuals to underes-

timate the amount of sugary drinks they actually 

consume (Flood et al., 2006; Nestle et al., 2015). 

Perhaps people believe that they have not con-

sumed in excess simply because there is still soda 

left in their cups; whatever the rationalization, such 

a lack of awareness of one’s consumption of a calori-

cally -dense beverage surely undermines individu-

als’ efforts to control their weight and may contrib-

ute to the failure of the consumption of liquid calo-

ries to reduce consumption of solid food calories 

(Malik, 2010). Given that 12 oz. of the average SSB 

contains about 140-150 calories (Malik, 2010), rela-

tively small increases in consumption can yield sig-

nificant increases in caloric intake. 
Beyond promoting the excess consumption 

of calories that may lead to weight gain and obesity, 

SSBs may pose more nuanced chronic disease risks 

due to their ability to promote visceral adiposity 

(Ma, 2016; Odegaard, 2012; Maersk et al., 2012) as 

well as the high glycemic load associated with their 

consumption (Hu & Malik, 2010). In a recent longitu-

dinal cohort study with 1003 adults of mean age 

45.3 years, Jiantao Ma and colleagues (2016) found 

that six years after initial biometric measurements 

were recorded, increasing SSB consumption fre-

quency correlated with increasing visceral adipose 

tissue (VAT) volume, or fat accumulatixon around 

the abdominal organs. Notably, no such correlation 

was found between diet soda consumption and VAT 

volume (Ma, 2016). Interestingly, SSB consumers 

were more likely to be engaged in slightly more 



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physical activity than SSB-non-consumers, yet this 

nuance did not protect them from the BMI increases 

and VAT volume increases observed at the end of 

the six-year interval of time (Ma, 2016). The signifi-

cantly higher increase in VAT mass found in the reg-

ular soda group in the aforementioned clinical trial 

by Maersk et al. (2012) further validates that SSBs in-

duce a VAT phenotype. VAT cells are known to se-

crete a variety of the pro-inflammatory type of small 

cell-signaling proteins known as cytokines (Alex-

opoulos et al.; 2014, Alvehus et al., 2010; Ohman et 

al., 2009). Such cytokines may increase the risk of 

atherosclerosis and associated cardiac events, 

given that cardiac events are associated with in-

creased circulating levels of inflammatory markers 

(Ohman et al., 2009). Proinflammatory cytokines are 

also capable of causing insulin resistance in adi-

pose, muscle, and liver tissues due to their inhibitory 

effects on insulin signaling pathways (de Luca & 

Olefsky, 2008) which may explain reported associa-

tions between proinflammatory, cytokine-releasing 

VAT and type 2 diabetes (Hanley et al., 2009). Addi-

tionally, the high glycemic loads associated with 

SSB consumption—which reflect a high content of 

simple carbohydrates capable of quickly raising 

blood sugar in standard portion sizes—are further 

linked to rises in inflammatory markers (Cerf, 2013). 

These high glycemic loads are further associated 

with pancreatic beta cell dysfunction and insulin re-

sistance, both of which are implicated in the patho-

genesis of type 2 diabetes (Cerf, 2013; LeRoith, 

2002).  

Unfortunately, methodological issues often 

inhibit the confidence with which one can draw con-

clusions from the results of studies addressing a 

possible link between SSBs and obesity (Bucher 

Della Torre et al., 2016; Pereira, 2006). Such issues 

may accordingly explain why a complete consensus 

on the relationship between SSBs and obesity is 

lacking despite the large body of evidence that sug-

gests a positive correlation. In a meta-analysis ad-

dressing the bias, generalizability, rigor of data anal-

ysis, and the conclusions drawn from 32 studies fo-

cused on SSBs and obesity in children and adoles-

cents, Bucher Della Torre and colleagues (2016) 

found that 23 of these studies had at least one meth-

odological issue. These methodological issues most 

commonly reflected incomplete or confounded 

study definitions of SSBs, unreliable measurements 

of exposure, or participant loss before follow-up in 

cohort studies. While only 9 of the analyzed studies 

had no methodological issues, all studies reported 

either a positive correlation between SSBs and obe-

sity or mixed results. On the other hand, the studies 

with methodological issues gave more inconsistent 

findings with some supporting the hypothesized 

link between SSBs and obesity, some reporting 

mixed results, and some finding no link at all.  

Moreover, industry funding may also con-

tribute to poor study quality. Following an analysis 

of 133 articles published between 2001 and 2013 

on the health effects of SSBs, Litman and colleagues 

reported that 82% of independently funded articles 

found strong evidence that SSBs have adverse ef-

fects on health, whereas only 7% of industry-funded 

articles reached such a conclusion (2018). Industry-

funded articles were more likely to report a weak or 

absent correlation between SSBs and adverse 

health effects, potentially owing to the non-experi-

mental basis of most of the industry-funded studies, 

which allows more room for bias (Litman et al., 

2018). Litman et al. acknowledge that no conclu-

sions about the quality of any individual article in-

cluded in the study can be drawn, as they did not 

analyze the scientific quality of the articles against 

any objective standards (2018). Nonetheless, the 

findings of Litman et al. (2018) and Bucher Della 

Torre et al. (2016) highlight the importance of scan-

ning for elements of potential bias and carefully an-

alyzing the methodology behind SSB studies before 

drawing conclusions, and further suggest that bi-

ases and flaws in the methodology of some past 

studies may understate the true contribution of SSBs 

to obesity and other adverse health effects. 

Taken altogether, the consensus becomes 

quite clear: SSBs are not health-promoting but 

health-harming, contributing to obesity and related 

chronic diseases. Given the economic and quality of 

life costs of obesity-related health conditions, public 

health initiatives to reduce consumption of SSBs are 

of vital importance. Unfortunately, however, existing 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

initiatives aimed at reducing consumption have 

generally been weak. The following section ex-

plores a possible reason for the lack of strong anti-

SSB action, briefly surveying the soda industry’s 

monetary involvement in perpetuating SSB con-

sumption. 

 

3 THE SODA INDUSTRY’S LIKELY ROLE 

IN PROMOTING GROWTH IN SSB CON-

SUMPTION & UNCLEAR PUBLIC HEALTH 

STANCES 
While the need to reduce SSB consumption 

to better protect against obesity and related health 

conditions is clear, industry opposition has made 

this reduction a challenging task. Indeed, SSB con-

sumption has not increased independently of indus-

try involvement. Coca-Cola, for instance, was origi-

nally sold in 6.5 oz. bottles, and in 1934, Pepsi-Cola 

made the first move in inflating portion sizes when it 

introduced a 12 oz. Pepsi for the same price of a 

nickel as its competitor’s 6.5 oz. drink, inflating its 

profits in the process (Dough, 2006). Today, the 

minimum size soda can is 7.5 oz. and bottle sizes 

range up to 2 liters (Nestle et al., 2015). Moreover, 

the standard soda size sold at gas stations and in 

vending machines is approximately 20 oz. and while 

one must account for the lost soda volume due to 

the addition of ice in fountain drinks, even a kid-size 

soda from a fast-food restaurant is twelve ounces 

(Nestle et al, 2015). Citing nationwide surveys of the 

portions of food Americans consume as justification 

for the change, the U.S. Food and Drug Administra-

tion even raised its soda serving size from 8 to 12 

ounces in 2014 (Center for Food Safety and Applied 

Nutrition, 2022). While the agency states that “the 

serving size is not a recommendation of how much 

to eat or drink,” (Center for Food Safety and Applied 

Nutrition, 2022) one must question why a nutrition-

focused branch of government would not speak 

about soda in less ambiguous terms given that the 

large body of research suggests that it is not a 

health-promoting beverage. Unsurprisingly, the 

food industry has been known to spend millions in 

political lobbying to influence government nutrition 

regulations and recommendations (Gostin, 2016; 

Nestle et al., 2015), suggesting a possible cause for 

the ambiguity in the FDA’s stance on soda and other 

SSBs. Perhaps further complicating the interests 

served by the FDA is the so-called “revolving door” 

between the food industry and related government 

agencies by which executives from the food indus-

try transition to high-power positions in government 

or vice versa, with little time in between. (Nestle et 

al., 2015; Piller, 2018; Hyman, 2020). Since 2009, 

the year a since-dropped federal soda tax was pro-

posed, annual lobbying expenditures from the soda 

industry alone have sat at $60 million (Du et al, 

2018). Clearly, the soda industry seems to have a 

vested interest in retaining its profits at the potential 

expense of the larger health interest of Americans.  

 

4 UNITED STATES SUGAR-SWEET-

ENED BEVERAGE EXCISE TAXES: PRO-

GRESS DESPITE INDUSTRY OPPOSITION  
Despite the dropped proposal to institute a 

nationwide SSB excise tax in 2009 and continued in-

dustry lobbying and opposition against SSB taxes 

(Nestle et al., 2015; McGranahan & Whitmore 

Schanzenbach, 2011; Gostin, 2017), several city-

level SSB excise taxes have since passed. In 2014, 

Berkeley, California became the first U.S. city to pass 

an excise tax of $0.01 per ounce on SSBs on account 

of public health interests (Falbe et al. 2016; Kane & 

Malik, 2019). November 2016 proved to be a re-

markable month, with five new SSB excise taxes 

ranging from $0.01 to $0.02 passed in Cook 

County, Illinois; Boulder, Colorado; and three cities 

in California’s Bay Area: San Francisco, Albany, and 

Oakland (Gostin, 2017; Kane & Malik, 2019). Stock-

ton, California and Philadelphia, Pennsylvania 

joined this growing list in June 2016, and Seattle, 

Washington in June 2017 (Kane & Malik, 2019). Un-

surprisingly, however, the American Beverage Asso-

ciation and the big soda companies it represents 

have fought many  such taxes, spending $19 million 

to fight the tax proposal in San Francisco alone 

(Gostin, 2017). The soda industry is known to fight 

excise tax proposals through claims that such taxes 

hurt small businesses and establish a “nanny state,” 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

in which the government infringes on the personal 

freedom individuals have to make their own choices 

as consumers (Gostin, 2017; Brownell & Warner, 

2009). Ironically, companies from this same industry 

often aggressively market their products to children 

and teens through television ads and digital media, 

hooking them at a young age and denying the ad-

dictive nature of the sugar and caffeine they contain 

(Brownell & Warner, 2009; Nestle et al., 2015; Falbe 

et al., 2019; Sylvetsky et al., 2020). Surely this very 

practice interferes with the ability of individuals to 

make their own autonomous decisions about 

whether or not to purchase SSBs, making the soda 

industry’s stance against SSB excise taxes hypocriti-

cal. Yet, while funding from philanthropists offered 

sufficient support to fight back and uphold the tax 

proposal in San Francisco (Gostin, 2017), proposals 

in other cities such as New York City, New York have 

nonetheless been dropped due to industry opposi-

tion of this sort (Kansagra et al., 2015). To examine 

the efficacy of SSB excise taxes more closely, Phila-

delphia’s tax will be examined in further detail.  

 

5 PHILADELPHIA AS A CASE STUDY 

FOR EVALUATING THE EFFICACY OF SSB 

EXCISE TAXES  
Officially known as the Philadelphia Bever-

age Tax (City of Philadelphia1, 2022), Philadelphia’s 

tax is particularly interesting, as the primary motive 

behind its proposal was to provide funding to sup-

port Mayor Jim Kenney’s initiative to make access to 

pre-kindergarten education universal (Kane & Malik, 

2019). Moreover, the tax was not only restricted to 

SSBs but also included any sweetened beverages 

(SBs), regardless of whether or not the sweetener 

contained calories (City of Philadelphia1, 2022; 

Kane & Malik, 2019). Examples of taxed beverages 

include both diet and regular soda, non-100%-fruit 

drinks, pre-sweetened tea and coffee drinks, and 

other pre-packed beverages sweetened with natu-

ral or artificial sweeteners (City of Philadelphia1, 

2022). The tax sits at $0.015 per ounce and is 

charged to all distributors of SBs, including restau-

rants, grocery stores, schools, hospitals, and even 

non-profit organizations (City of Philadelphia1, 

2022).  

Distributors have passed 43-104% of the 

Philadelphia SB excise tax onto consumers, de-

pending on the outlet of purchase (Madsen et al., 

2019). The cost of SBs increased by $0.0065 per 

ounce in supermarkets, $0.0087 per ounce in mass 

merchandiser outlets, and $0.0156 per ounce in 

pharmacies (Roberto et al., 2019). Just one year af-

ter the excise tax was implemented on January 1, 

2017 (Madsen et al., 2019), an analysis of retail sales 

from January 1, 2014, to December 31, 2017, re-

vealed that total volume retail sales of SBs in Phila-

delphia had declined by 51% compared to sales 

prior to tax implementation (Roberto et al., 2019). 

However, it should be noted that sales of SBs in 

Pennsylvania zip codes surrounding Philadelphia in-

creased, offsetting 24.4% of this 51% decline (Rob-

erto et al., 2019). The net decline in SB sales brought 

about by implementation of the excess tax therefore 

appears to be approximately 38% (Roberto et al., 

2019),. However, data on SB sales were not evalu-

ated in New Jersey and could have further offset this 

decline, despite the disincentive of toll charges to 

travel across the border (Roberto et al., 2019). 

Nonetheless, the effectiveness of the SB tax in de-

terring SB purchases is promising. Henceforth, the 

following question arises: Do reduced purchases 

equate to significantly reduced consumption across 

the population in Philadelphia?  

One longitudinal survey-based study exam-

ined soda drinking in one adult and one child from 

several hundred households in Philadelphia and 

comparison areas in Delaware; Montgomery 

County, Pennsylvania; or Bucks County, Pennsylva-

nia before and after implementation of the Philadel-

phia Beverage Tax. The study revealed that 10 to 11 

months after implementation of the tax, Philadel-

phian adults consumed about 1 less regular soda 

every 3 days (Cawley et al., 2019). Amongst African 

American adults in particular, the SB tax resulted in 

the consumption of 1 less regular soda every 2 days, 

suggesting that the effects of the tax may differ 

amongst sociodemographic groups (Cawley et al., 

2019). Interestingly, however, Cawley et al. did not 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

report any statistically significant differences be-

tween socioeconomic groups (2019) despite the 

fact that SSB consumption tends to be higher 

amongst low-income individuals (CDC2, 2022). 

While no significant differences in soda consump-

tion were reported amongst all Philadelphian chil-

dren after the tax, children who consumed the 

amount of sugar equivalent to that in a 20 oz. regu-

lar soda on a daily basis, or 67 grams per day, con-

sumed 22% less added sugar after implementation 

of the tax (Cawley et al., 2019), suggesting that the 

tax may have a more significant impact on individu-

als who were preexisting high-sugar consumers. It 

should be noted that Cawley et al. used different 

samples of participants to make pre- and post-tax 

comparisons, potentially blurring the true, unadul-

terated effects of the tax of SB consumption. 

Another cross-sectional survey-based study 

conducted at Drexel University used random-dial-

ing phone call data from 899 Philadelphian partici-

pants and 878 nearby-comparison-area participants 

to determine that Philadelphians were 40% less 

likely to consume regular soda, 64% less likely to 

consume energy drinks, and 58% more likely to con-

sume bottled water following implementation of the 

SB tax. However, this reported change was based 

on data collected only 1-2 months after the tax had 

been put into practice and therefore may not accu-

rately reflect its long-term effects (Zhong et al., 

2018). Notably, a recent, more long-term study with 

a similar random-dialing phone call survey design 

conducted by some of the same Drexel University 

researchers revealed that there were no significant 

overall differences in either SSB or diet SB consump-

tion before and 12 months after tax implementation 

(Zhong et al., 2020). Further, there were no signifi-

cant differences in such consumption between Phil-

adelphians (n=357) and non-Philadelphians 

(n=158), though a slightly higher percentage of Phil-

adelphian participants decreased their SSB con-

sumption compared to the non-Philadelphians par-

ticipants (Zhong et al., 2020). Yichen Zhong and col-

leagues do however acknowledge that the sample 

size for this study was small (2020). Moreover, the 

survey-based design of the study carries risk of bias, 

though accurately measuring changes in soda con-

sumption (rather than purchases) via other methods 

would likely prove difficult. Table 1 summarizes the 

basic characteristics of the aforementioned studies, 

examining the effect of Philadelphia’s excise tax on 

SB consumption.  

Studies examining the impact of the SSB tax 

instituted in Berkeley, California on SSB consump-

tion have reported a similar mix of findings, thus 

supplementing the relatively small pool of studies 

on Philadelphia’s SB tax to strengthen the degree to 

which conclusions can be drawn about the general 

effects of SSB/SB taxes on purchasing behavior. 

One short-term study found that the tax in Berkeley 

brought about a 21% reduction in SSB consumption 

in low-income neighborhoods (Falbe et al., 2016), 

and another longer-term study reported no signifi-

cant difference in self-reported SSB consumption 

one-year after tax implementation despite signifi-

cant declines in SSB sales (Silver et al, 2017). On the 

other hand, the results of one exceptionally long-

term study that surveyed differences in consump-

tion before and after implementation of the tax 

amongst individuals from demographically diverse 

Berkeley neighborhoods (n = 1513) and compari-

son neighborhoods in San Francisco and Oakland 

(n = 3712) revealed that the frequency of SSB con-

sumption in Berkeley decreased by 0.55 times per 

day after tax-implementation based on a compari-

son of pre-tax consumption to a weighted average 

of consumption during the first 3 years post-tax-im-

plementation. Water consumption comparably in-

creased by 1.02 times per day during the same time 

period (Lee et al., 2019). While it should be noted 

that the cities from which the comparison neighbor-

hoods were selected both passed SSB taxes in 

2016, only a portion of the final 2017 surveys in Oak-

land were collected after these taxes were imple-

mented (Lee et al., 2019). Table 2 summarizes the 

basic characteristics of the aforementioned studies 

examining the effect of Berkeley’s excise tax on SSB 

consumption. 

 
  



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TABLE 1:  Population Characteristics and Methodology for Studies Evaluating Post-Taxation Changes in SB Consumption in 

Philadelphia, PA 

 

The similarly varied findings of the studies in 

Berkeley and Philadelphia and the limitations of the 

survey-based studies generally used to measure 

SSB consumption necessitate that further long-term 

studies with larger sample sizes be conducted be-

fore more conclusive claims are drawn on the true 

efficacy of SSB or SB excise taxes on SSB consump-

tion. Nonetheless, the existing evidence suggest 

that such taxes likely have some degree of efficacy.  

Setting conclusions about the true efficacy 

of SSB and SB excise taxes aside, the Philadelphia 

Beverage Tax has generated an impressive amount 

of revenue despite the significant reductions in soda 

volume purchased in the city after tax implementa-

tion (Roberto et al., 2019). As of the end of the fourth 

fiscal quarter of 2021, the tax had generated $333.9 

million since its enactment in 2017 (Rhynhart, 2022). 

Taking annual revenue to be consistent for the pur-

poses of generating an average, the tax has gener-

ated roughly $66.8 million annually (Rhynhart, 

2022). $122 million, or 37% of the tax’s overall reve-

nue, has been spent on pre-kindergarten educa-

tion, and significantly smaller amounts have gone 

towards community schools, the city’s Office of Ed-

ucation and Rebuild, the city’s new program fo-

cused on rebuilding community parks, libraries, and 

recreation centers (Rhynhart, 2022; City of Philadel-

phia2, 2022). While the city claims that Rebuild will 

devote hundreds of millions of dollars to its initia-

tives thanks to the SB tax (City of Philadelphia2, 

2022), $179 million, or 54%, of Philadelphia’s SB tax 

revenue still remains in the city’s General Fund 

(Rhynhart, 2022). Despite City Controller Rebecca 

Rhynhart’s repeated pushes for SB tax funds to be 

Authors, 
Year 

Participant Recruitment Analytic Sample Characteristics 
Data Col-

lection 
Method 

Length of 
Time Between 

Tax Imple-
mentation & 
Evaluation 

 

Cawley 
et al., 
2019 

Separate groups of par-
ticipants recruited out-
side of grocery stores at 
baseline and follow-up 
timepoints. 

Baseline 2016 data for N=600 
Philadelphian households, 
N=705 comparison households 
from Delaware and other Penn-
sylvania areas; Follow-up 2017 
data for N=763 Philadelphian 
households, N=738 comparison 
households from Delaware and 
other Pennsylvania areas 

Online 
survey (by 
phone for 
those who 
could not 
complete 
online) 

10-11 months 

Zhong et 
al., 2018 

Part of the Drexel Univer-
sity Beverage Choice Re-
search Study. Recruit-
ment via random-digit 
phone dialing. 

N=899 Philadelphian house-
holds, N=878 comparison 
households from cities in New 
Jersey and Delaware 

Phone 
survey 

1-2 months 

Zhong et 
al., 2020 

Participants from the 
Drexel University Bever-
age Choice Research 
Study recontacted 1 year 
after recruitment via ran-
dom-digit phone dialing 
for initial surveying. Par-
ticipants paid $20 for fol-
low-up survey only. 

N=479 Philadelphian house-
holds, N=384 comparison 
households from cities in New 
Jersey and Delaware 

Phone 
survey 

1 year 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

separated from the General Fund to ensure trans-

parent spending, no changes have been made 

(McCrystal, 2019; Rhynhart, 2022). The spending 

timeline and specific allocation of remaining reve-

nue remains unclear, with only vague commentary 

from Mayor Jim Kenney’s office claiming that it 

would take time for the rate of revenue influx from 

the SB tax to become outpaced by the rate at which 

programs intended to be supported by such reve-

nue can utilize the funds to develop (McCrystal, 

2019). In the meantime, of course, tax revenue will 

continue to accumulate so long as the tax remains 

in effect. In the final section to follow, I propose the 

allocation of at least a portion of the revenue gener-

ated by the Philadelphia SB excise to fund con-

sumer-level fruit and vegetable subsidies as a pos-

sible means of not only ensuring that tax revenue is 

spent in a timely manner, but also enhancing the 

tax’s potential to combat obesity. 

 
TABLE 2:  Population Characteristics and Methodology for Studies Evaluating Post-Taxation Changes in SB Consumption in 

Berkeley, CA 

Authors, 
Year 

Participant 
Recruitment 

Analytic Sample Characteristics 
Data Collection 

Method 

Length of Time 
Between Tax Im-
plementation & 

Evaluation 
 

Falbe et 
al., 2016 

Separate 
groups of par-
ticipants re-
cruited via in-
tercept survey-
ing at high-traf-
fic intersections 
at baseline and 
follow-up 
timepoints. 

Baseline 2014 data for N=285 
Berkeley participants, N=606 com-
parison participants from Oakland 
and San Francisco, CA; Follow-up 
2015 data for N=501 Philadelphian 
participants, N=1045 comparison 
participants from Oakland and San 
Francisco, CA. Participants re-
cruited from low-income neighbor-
hoods with large minority popula-
tions. 

In-person inter-
view  

4 months 

Silver et 
al., 2017 

Participants re-
cruited via 
landline and 
cellular ran-
dom-digit 
phone dialing 
for initial sur-
vey 

Baseline 2014 measurements for 
N=649 Berkeley participants; Fol-
low-up 2015 measurements for 
N=654 participants. Low-income 
census blocks were disproportion-
ately favored during random-digit 
dialing recruitment.  

Phone survey 1 year 

Lee et al., 
2019 

Separate 
groups of par-
ticipants re-
cruited via in-
tercept survey-
ing at high-traf-
fic intersections 
at baseline and 
follow-up 
timepoints. 

Baseline 2014 data for N=1513 
Berkeley participants, N=3712 
comparison participants from Oak-
land and San Francisco, CA; Un-
specified sample sizes for follow-
up data collected in 2015, 2016, 
and 2017. Participants recruited 
from low-income neighborhoods 
with large minority populations. 

In-person inter-
view 

3 years, plus an-
nual follow-up 

 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

6 FRUIT & VEGETABLE SUBSIDIES: AN 

ALTERNATIVE OBESITY-MINDED INVEST-

MENT FOR PHILADELPHIA’S SWEETENED-

BEVERAGE EXCISE TAX REVENUE  
Though additional research is needed to 

know the full extent to which SSB taxes reduce soda 

consumption, existing evidence from U.S.-based 

studies in relevant cities like Berkeley and Philadel-

phia suggests that such taxes are effective to at least 

some extent (Bleich & Long, 2020). And while the 

Philadelphia SB excise tax in particular was, again, 

not proposed with obesity as a primary motive 

(Kane & Malik, 2019), positive externalities are never 

unwelcomed. Yet, one has to question why the 

$150.9 million in tax revenue in the General Fund 

has not yet been devoted to fulfilling the mayor’s 

mission of funding universal pre-K or supporting the 

mission of Rebuild (Kane & Malik, 2019; City of Phil-

adelphia2, 2022). The Philadelphian public ought to 

demand that this revenue be reinvested within a set 

period of time, yet given the present lack of action 

and the burden of obesity in America, perhaps at 

least a portion of this revenue might be better spent 

directly funneled into programs that further fight 

obesity. I suggest a program that funds fruit and 

vegetable subsidies, whereby government funding 

would artificially lower the cost of such foods.  

It is generally well accepted that increasing 

consumption of whole fruits and vegetables is in-

versely associated with weight gain and obesity 

(Guyenet, 2019; Nour et al., 2018; Dreher, 2018; He 

et al., 2004). Possible causes for this correlational 

trend are the relatively low energy and high fiber 

content of fruits and vegetables, as well as their con-

stituent plant phytochemicals (Dreher, 2018). More-

over, increasing fruit and vegetable consumption 

may reduce the risk of cardiovascular disease, hy-

pertension, stroke, and certain cancers (Boeing et 

al., 2012; Hung et al., 2004). Despite the fact that 

most data on the health effects of fruits and vegeta-

bles is correlational, there is no significant evidence 

to suggest that fruits and vegetables are harmful, 

and the science-backed 2020-2025 Dietary Guide-

lines for America recommend filling half your plate 

with whole fruits and vegetable (USDA, 2022). Yet 

according to nationwide 2013 Behavioral Risk Fac-

tor Surveillance System (BRFSS) data, only 12.3% of 

Americans meet the fruit intake recommendations 

laid out by the 2015-2020 Dietary Guidelines for 

Americans, and only 9.3% of Americans meet the 

vegetable intake recommendations (Lee-Kwan et 

al., 2015). For many Americans, however, complex 

socioeconomic factors, such as the relatively high 

cost of fruits and vegetables and limited access, 

make their low intake of such foods more than a 

matter of personal preference (Lee-Kwan et al., 

2015).  

Regarding cost barriers to accessing fruits 

and vegetables, relatively few interventional studies 

have explored the effectiveness of subsidies in pro-

moting the purchase of healthy food (An, 2013; Her-

man et al., 2008; Pearson-Stuttard et al., 2017). Sig-

nificantly, however, in one Los Angeles-based study 

amongst 602 postpartum women enrolled in the 

Special Supplemental Nutrition Program for 

Women, Infants, and Children (WIC), researcher 

Dena Herman and colleagues issued participants in 

the experimental group $10 worth of vouchers per 

week on a bimonthly basis to spend at either a farm-

ers market site or a supermarket site over a 6-month 

intervention period (2008). Survey data revealed 

that compared to control participants, who were 

given a monthly $13 dollar voucher to spend on dis-

posable diapers, farmer’s market participants in the 

experimental group consumed 1.4 additional serv-

ings of fruits and vegetables per 1000 kcal in con-

trast to baseline, and supermarket participants con-

sumed 0.8 additional servings per 1000 kcal (Her-

man et al., 2008). Remarkably, the reported in-

creases in consumption were maintained 6 months 

after participants stopped receiving the vouchers 

(Herman et al., 2008). Such a finding suggests that 

even short periods of fruit and vegetable subsidiza-

tion might have sufficiently positive effects on indi-

viduals to establish resilient changes in long-term 

purchasing behavior. 

If drawn out for a year, Herman et al.’s fruit 

and vegetable subsidy intervention would cost 

$480 per WIC participant (2018). According to U. S. 

Department of Agriculture (USDA) data, there were 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

233,500 enrolled WIC participants in Pennsylvania 

as of 2016 (USDA, 2019). No further data is available 

on the breakdown of this state-wide data, however 

(USDA, 2019). Employing Herman et al.’s interven-

tion amongst all Pennsylvania WIC participants for 

one year would theoretically cost approximately 

$112 million, almost double the $65.1 million aver-

age annual revenue generated by the Philadelphia 

SB excise tax (Rhynhart, 2019). Further information 

about the number of WIC participants in Philadel-

phia is needed before conclusions can be drawn 

about the feasibility of establishing such an inter-

vention. However, even if the vast majority of the 

233,500 enrolled WIC participants in Pennsylvania 

were enrolled in Philadelphia, funding might still be 

feasible with SB tax revenue if weekly subsidies 

were cut by a small percentage or if funding was re-

ceived more intermittently throughout the year.  

Importantly, the findings of a recent longitu-

dinal cohort study of SNAP beneficiaries throughout 

North Carolina further support the efficacy of fruit 

and vegetable subsidies in encouraging more 

healthful dietary consumption (Berkowitz et al., 

2021). Compared to those registered for standard 

SNAP benefits alone (N=33246), those receiving an 

additional $40 per month through enrollment in Su-

perSNAP, established to fund only the purchase of 

fresh, frozen, or canned fruits and vegetables free of 

added sugar and salt, purchased an average of 

$31.84 more of fruits, vegetables, nuts, and leg-

umes per month. While it follows that enrollment in 

SuperSNAP did not increase out-of-pocket spend-

ing on fruits, vegetables, and other whole foods, it 

nonetheless produced a significant shift in purchas-

ing behavior. This shift also included a significant 

decrease in spending on both processed foods and 

sugar-sweetened beverages, though because Su-

perSNAP beneficiaries were enrolled in the pro-

gram by clinical staff due to pre-existing health con-

ditions (e.g., diabetes or obesity), there is the possi-

bility that such beneficiaries may have been rela-

tively biased towards healthy eating. Nonetheless, 

this study further supports the theory that lowering 

the cost barrier to accessing fruits and vegetables 

can potentially induce a measurable change in die-

tary consumption, which one can presume aligns 

reasonably well with food purchasing behavior. 

Ultimately, WIC participants pose a more 

economically feasible target population for a sub-

sidy program in Philadelphia than SNAP partici-

pants, as significantly more individuals are enrolled 

in the latter: as of 2021, 464, 008 individuals were 

receiving SNAP benefits in Philadelphia alone (U.S. 

Census Bureau, 2022). Additionally, given that re-

search suggests that parental modeling and expo-

sure to foods during childhood plays a significant 

role in shaping long-term feeding behavior (Birch et 

al., 2007; Vollmer & Baietto, 2017; Ventura & 

Worobey, 2013; Wadhera et al., 2015), subsidizing 

fruits and vegetables for WIC participants might 

generate self-perpetuating positive effects on diets 

across generations.  

Beyond subsidizing fruit and vegetables for 

WIC participants, tax revenue from the Philadelphia 

SB excise tax might alternatively be used to lower 

the cost of fruit and vegetable subsidies on a some-

what broader scale. Amongst other findings, a 

meta-analysis of 23 interventional studies and 7 pro-

spective cohort studies selected from 3,163 re-

viewed abstracts related to the impact on price 

changes on diet identified that just a 10% decrease 

in fruit and vegetable prices resulted in a 14% in-

crease in fruit and vegetable purchases (Pearson-

Stuttard et al., 2017). Such findings suggest that us-

ing a portion of the SB tax revenue to subsidize se-

lect fruits and vegetables in Philadelphia might pro-

duce a measurable rise in purchases of these health-

promoting foods. Perhaps such subsidies might be 

better selectively applied to grocery stores or 

farmer’s markets serving lower-income neighbor-

hoods, where the existing costs of fruits and vegeta-

bles pose more of a significant access barrier.  

While additional expertise in economics, 

data science, and public health beyond the scope of 

this synthesis paper is needed to propose a specific 

and practicable plan for using tax revenue from the 

Philadelphia SB excise tax to subsidize fruits and 

vegetables, the aforementioned studies suggest 

that subsidizing fruits and vegetables could pro-



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

  

 

 

duce measurable results. Indeed, the available evi-

dence indicates that targeting smaller populations 

or select fruits and vegetables could make the costs 

of the subsidies realistic, given existing revenue 

from the taxes. Moreover, such subsidies might help 

support Philadelphia grocery stores, which appear 

to have suffered losses after implementation of the 

tax in 2017. A few months after the tax had been put 

into practice, the owner of 6 ShopRite stores in Phil-

adelphia, Jeff Brown, told National Public Radio that 

his sales were down 15%, leaving him with no 

choice but to cut hours for his Union employees (Au-

brey, 2017). Sales presumably underwent such a re-

markable drop due to some individuals choosing to 

shop outside of Philadelphia to avoid the tax (Au-

brey, 2017), and whether or not this drop lessened 

over time is unclear. Nonetheless, the number is 

striking. Subsidizing fruits and vegetables while sim-

ultaneously taxing SBs might help to bring back 

some of this lost business in Philadelphia.  

 

7 CONCLUSION 
Obesity has been on the rise since the late 

1970s, and its massive health and economic conse-

quences cannot be ignored. While SSB excise taxes 

are by no means capable of resolving this public 

health threat altogether, existing evidence reasona-

bly supports the use of such taxes, as SSBs have 

been shown to promote weight gain and chronic 

disease, and this scientific consensus might be even 

more clear if methodological issues and probable 

industry-biases in some studies and reviews were 

eliminated. SSB excise taxes, though still few and far 

between, seem to hold some efficacy in reducing 

the purchase and consumption of SSBs. Yet, while 

these taxes generate valuable revenue, their obe-

sity-fighting potential might be optimized if such 

revenue were devoted to addressing other factors 

that contribute to the obesity equation. Fruit and 

vegetable subsidies pose one such promising pos-

sibility and might help to combat lost business gen-

erated by SB/SSB excise taxes in cities like Philadel-

phia, where the majority of SB tax revenue gener-

ated since its 2017 inception remains unspent.  

Despite inevitable industry opposition, 

bringing back a federal proposal for a SSB excise 

ought to be the ultimate goal, as this more unified 

approach would maximize public health benefits 

and likely rid retail stores in cities with existing 

SB/SSB taxes of the issue of lost revenue that may 

emerge when some individuals resultingly choose 

to shop for groceries in areas with no such taxes. Un-

til then, however, cities like Philadelphia ought to 

continue to act as role models and work to improve 

their SB/SBB tax programs to optimize their obesity-

fighting potential, setting examples that will hope-

fully ignite a larger movement∎ 
 

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ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. 
 

Sarah Pfreundschuh is a class of 2022 graduate from Rutgers Honors College 

and the School of Environmental and Biological Sciences. She majored in nu-

tritional science and minored in biochemistry, completing wet lab research on 

the metabolic functions of stearoyl CoA desaturase enzymes. Separately, she 

pursued literature-based research on the adverse health effects of sugar-

sweetened beverages and the leveraging of tax-based solutions to best ad-

dress such effects as a term project for a class taught by nutritional sciences 

professor Dr. Joseph L. Dixon, titled “Obesity: Biology, Behavior, and Manage-

ment.” Sarah currently interns at a functional medicine practice and hopes to 

attend medical school to pursue a career as a functional medicine physician, 

focusing on disease prevention and root-cause-oriented, systems-based ap-

proaches to the diagnosis and treatment of existing chronic health conditions. 

She holds related side interests in sustainable agriculture and initiatives that 

increase access to nutrient-dense foods and enjoys cooking, yoga, and spend-

ing time outdoors in her free time. 


