sodaVoters made history Tuesday in Berkeley, California, by imposing a per-ounce tax on sodas and other sweetened beverages – a result welcomed by proponents as a breakthrough in the fight against America’s obesity epidemic.

San Francisco also had a measure on the ballot, but it did not pass by the required two-thirds margin.

“Today the voters of Berkeley delivered a big win for not only the health of their children, but children across the country by demonstrating that cities and their residents have the power to initiate positive change,” said Nancy Brown, CEO of the American Heart Association, which supported the measure. “We commend Berkeley for rejecting the big spending and false arguments of outsiders and standing up for what they knew was right for their community.”

Berkeley is the first city in the nation to approve a penny-per-ounce tax, which will raise an estimated $1 million to $3 million annually. The taxes target primarily sodas, iced tea and energy drinks. Exceptions include milk, medicine and alcohol.

San Francisco voters were considering two cents per ounce on sugary drinks, which would have generated about $30 million a year.

The votes in the neighboring cities set off a fierce head-to-head campaign featuring millions of dollars in spending between the beverage industry and proponents of the tax, led by public health officials and activists armed with studies that say sugar-sweetened beverages are associated with higher rates of diabetes, obesity, heart disease and strokes.

Other cities and states will follow suit, Harold Goldstein, executive director of the California Center for Public Health Advocacy, said before the election. Previously, no other town had been successful despite several attempts in recent years. Mexico passed a soda tax that began in 2014, and sales and consumption have apparently declined as a result.

“We fully expect other communities to take on the soda industry and succeed,” said Dr. Vicki Alexander, a co-chair on the Berkeley campaign to pass the ballot initiative, known as Measure D. “Berkeley has a proud history of setting nationwide trends, such as nonsmoking sections in restaurants and bars, curb cuts for wheelchairs, curbside recycling and public school food policies. Many communities have the same ingredients that made Measure D possible in Berkeley: proactive parents and community leaders who care about the health of their kids.”

Evidence shows adults should not consume more than about 36 ounces, or 450 calories, each week of sugar-sweetened beverages, Brown said. Yet the average 8-year-old boy consumes 8 servings, or 64 ounces, each week.

“Sugary drinks are an unnecessary part of the American diet that decades ago were just a treat and are now guzzled at alarming rates,” Brown said. “From sports drinks to sodas to fruit-flavored drinks, today’s children are drinking their age in these sugary drinks each week.”

Yerem Yeghiazarians, M.D., the San Francisco American Heart Association board president, praised the issue as key in the ongoing fight against obesity.

“We want to help grow a heart-healthier generation and we’re proud to lead the country in our efforts to reduce sugary drinks consumption,” he said.

The American Beverage Association, the lobbying group for the soda industry, has argued the tax is an unnecessary government intrusion and a regressive tax that hurts business.

“If we want to get serious about obesity, it starts with education – not laws and regulation,” the group said in a blog post. The ABA has started a group called YourCartYourChoice.com to “keep politicians out of your grocery cart.”

The pressure in Berkeley, with its 80,000 voters, had been intense, with door-to-door canvassing, mailers, and radio and television advertising. The ABA spent $2.3 million. Proponents for the ballot’s Measure D raised $325,943 in cash – including $23,000 from the American Heart Association – and $411,597 in in-kind contributions.

In all, the beverage industry spent about $10 million on the fight in California.

Until recently, much of the measure’s support came from local organizations, donating in small amounts and devoting volunteer time.

In the past few weeks, former New York Mayor Michael Bloomberg, who fought unsuccessfully to establish a cap on the size of soda portions sold in that city, donated $170,000 to the Berkeley campaign.

He also donated $362,071 in television ad production and placement for a baseball-themed TV ad in the Bay Area during the weekend World Series games. It says, “The number of obese and overweight Bay Area children could fill our baseball stadium three times… But on Nov. 4, we get a chance to change the game.”

The latest infusion of money helped hire more neighborhood canvassers and produce more fliers, said Sara Soka, manager for the Berkeley vs. Big Soda campaign. “It is the David versus Goliath story. Even with the money coming in recently, the soda industry is still far outspending us.”

But she is optimistic the city will start a movement across the nation, she said. “Berkeley is looked up to as a trendsetter in public health issues. It was one of the first cities to set aside smoke-free areas in restaurants in the 70s … People do look at Berkeley, and it will spread. We happen to be fertile ground. The community has a high degree of readiness for this soda tax.”