School food & beverage restrictions
School food and beverage restrictions regulate the availability and quality of competitive foods not provided through the National School Lunch Program and School Breakfast Program. Such restrictions can include items sold as à la carte options, in vending machines, school stores, or at fundraisers, and can be a full ban or a limit on sale times. Federal guidelines establish minimum nutrition standards for competitive foods, including limits for sugar, sodium, saturated fat, and total fat content; state and local guidelines can establish additional quality and availability restrictions for competitive foods. Many children consume as much as half of their daily calories at school and may consume over a quarter of their daily calories in snacks1, 2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved dietary choices
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced unhealthy food sales
Improved food environment
Reduced unhealthy food consumption
Reduced sweetened beverage consumption
Improved weight outcomes
What does the research say about effectiveness?
There is some evidence that school food and beverage restrictions lead to healthier diets among children3, 4, 5, 6, 7, 8, 9, 10. Competitive foods are highly available in schools11. School policies to restrict competitive foods and beverages are associated with reduced in-school availability and in-school consumption of unhealthy foods and beverages12. Additional research is needed to confirm effects on overall consumption and weight outcomes11, 12.
Middle school students in schools with more nutrition and healthy food environment policies that restrict and replace competitive foods at lunch with healthy alternatives have greater dietary improvements than peers in schools with fewer or no such policies3. Limiting access to unhealthy foods has been associated with significant but small reductions in unhealthy food sales9, 13. Policies that limit access to competitive foods are associated with greater fruit and vegetable intake at school and are not associated with decreases in National School Lunch Program (NSLP) participation; on average, NSLP participants consume more fruits and vegetables at school than nonparticipants4. Among middle school students, such policies appear to decrease consumption of foods with low nutritional value at school, without an offsetting increase in consumption at home14. Adolescents with access to competitive foods through school cafeteria snack bars consume fewer healthy foods and nutrients than those without access to such foods15, 16. However, policies limiting access to unhealthy foods do not appear to increase overall fruit and vegetable consumption17.
Limits on sugar sweetened beverages (SSBs) and snacks have been shown to increase consumption of healthy foods and milk in some circumstances7, 18. Efforts to restrict the availability of SSBs have been shown to reduce consumption for kindergarteners8 and high school students in Boston6, but a study of middle schoolers finds no such reduction13. School district-wide restrictions on competitive beverage sales can reduce the availability of SSBs and improve the school food environment19. In one study, state policies restricting SSB availability are associated with reduced consumption of SSBs among African-American students, but not the overall population20. In a study of 5th and 8th grade students, competitive beverage availability was associated with increased consumption of SSBs among males, minorities, and children living in poverty17.
State-wide school food and beverage restrictions are associated with improved school food environments20, 21, 22. School compliance with state competitive food policies may increase over time23, although substantial improvements to school food environments can be made in the first year of implementing state regulations21.
States with strong laws governing competitive food nutrition content across grade levels may reduce adolescent body mass index (BMI) increases and the likelihood of adolescents remaining overweight24. Data analysis suggests state policies may have stronger effects than district-level policies20. A study of children in military families suggests both strong and weak state policies regulating competitive foods and beverages are associated with better dietary outcomes, lower body mass index (BMI) scores, and lower odds of children being overweight or obese, compared to states without such policies5. A California-based study connects state and district-level policies limiting access to competitive foods with improvements in overall overweight trends in 5th grade boys and 7th graders25; however, other studies do not show an association between competitive food sales and weight gain for children in grades 5 through 826.
State-wide school competitive food and beverage policies are associated with population-level reductions in the prevalence of childhood overweight and obesity; however, such policies appear to be more effective in more advantaged schools and neighborhoods than in disadvantaged schools and neighborhoods. Experts suggest such policies also need to address contextual factors in school neighborhoods for policies to successfully reduce disparities in the prevalence of childhood overweight and obesity27.
A Connecticut-based study suggests that competitive food restrictions can increase school lunch participation and increase school district revenue28.
How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples
As of 2014-2015, the federal Smart Snacks in School regulation requires that all foods sold in school during the school day meet nutrition guidelines, which includes foods sold à la carte, in the school store, and in vending machines29. These federal requirements are a minimum standard; state and local policies can establish stricter guidelines and restrictions2.
Implementation Resources
CDC MMWR-School health guidelines 2011 - National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (DASH). School health guidelines to promote healthy eating and physical activity. Morbidity and Mortality Weekly Report (MMWR). 2011:60(RR-05):1-71.
USDA-Smart snacks tools - U.S. Department of Agriculture (USDA), Food and Nutrition Service. Tools for schools: Focusing on Smart Snacks.
USDA-School food standards - U.S. Department of Agriculture (USDA). Nutrition standards for all foods sold in school.
Footnotes
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1 CDC-School nutrition - Centers for Disease Control and Prevention (CDC). CDC healthy schools: School nutrition.
2 USDA-Smart snacks guide 2019 - U.S. Department of Agriculture (USDA). Help make the healthy choice the easy choice for kids at school: A Guide to Smart Snacks in School for school year 2019-2020. 2019.
3 Alaimo 2013 - Alaimo K, Oleksyk SC, Drzal NB, et al. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children's diets. Childhood Obesity. 2013;9(6):509-523.
4 Ishdorj 2013 - Ishdorj A, Crepinsek MK, Jensen HH. Children’s consumption of fruits and vegetables: Do school environment and policies affect choices at school and away from school? Applied Economic Perspectives and Policy. 2013;35(2):341-359.
5 Datar 2017 - Datar A, Nicosia N. The effect of state competitive food and beverage regulations on childhood overweight and obesity. Journal of Adolescent Health. 2017;60(5):520-527.
6 Cradock 2011 - Cradock AL, McHugh A, Mont-Ferguson H, et al. Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006. Preventing Chronic Disease. 2011;8(4):A74.
7 Gonzalez 2009 - Gonzalez W, Jones S, Frongillo E. Restricting snacks in U.S. elementary schools is associated with higher frequency of fruit and vegetable consumption. Journal of Nutrition. 2009;139(1):142–4.
8 Fernandes 2008 - Fernandes MM. The effect of soft drink availability in elementary schools on consumption. Journal of the American Dietetic Association. 2008;108(9):1445-52.
9 Jaime 2009 - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53.
10 Larson 2010 - Larson N, Story M. Are “competitive foods” sold at school making our children fat? Health Affairs. 2010;29(3):430–5.
11 Silden 2018 - Sildén KE. Impact of competitive foods in public schools on child nutrition: Effects on adolescent obesity in the United States an integrative systematic literature review. Global Health Action. 2018;11(1):1477492.
12 Chriqui 2014 - Chriqui JF, Pickel M, Story M. Influence of school competitive food and beverage policies on obesity, consumption, and availability: A systematic review. The Journal of the American Medical Association Pediatrics. 2014;168(3):279-286.
13 Taber 2012a - Taber DR, Chriqui JF, Powell LM, Chaloupka FJ. Banning all sugar-sweetened beverages in middle schools: Reduction on in-school access and purchasing but not overall consumption. Archives of Pediatrics & Adolescent Medicine. 2012;166(3):256-62.
14 Schwartz 2009 - Schwartz MB, Novak SA, Fiore SS. The impact of removing snacks of low nutritional value from middle schools. Health Education & Behavior. 2009;36(6):999-1011.
15 Cullen 2004 - Cullen KW, Zakeri I. Fruits, vegetables, milk, and sweetened beverages consumption and access to à la carte/snack bar meals at school. American Journal of Public Health. 2004;94(3):463–7.
16 Templeton 2005 - Templeton SB, Marlette MA, Panemangalore M. Competitive foods increase the intake of energy and decrease the intake of certain nutrients by adolescents consuming school lunch. Journal of the American Dietetic Association. 2005;105(2):215–20.
17 Vericker 2013 - Vericker TC. Limited evidence that competitive food and beverage practices affect adolescent consumption behavior. Health Education & Behavior. 2013;40(1):19–23.
18 Whatley Blum 2008 - Whatley Blum JE, Davee A-M, Beaudoin CM, et al. Reduced availability of sugar-sweetened beverages and diet soda has a limited impact on beverage consumption patterns in Maine high school youth. Journal of Nutrition Education and Behavior. 2008;40(6):341-7.
19 Mozaffarian 2016 - Mozaffarian RS, Gortmaker SL, Kenney EL, et al. Assessment of a districtwide policy on availability of competitive beverages in Boston public schools, Massachusetts, 2013. Preventing Chronic Disease. 2016;13:150483.
20 Terry-McElrath 2015 - Terry-McElrath YM, Chriqui JF, O’Malley PM, et al. Regular soda policies, school availability, and high school student consumption. American Journal of Preventive Medicine. 2015;48(4):436-444.
21 Hoffman 2015a - Hoffman JA, Rosenfeld L, Schmidt N, et al. Implementation of competitive food and beverage standards in a sample of Massachusetts schools: The NOURISH study (Nutrition Opportunities to Understand Reforms Involving Student Health). Journal of the Academy of Nutrition and Dietetics. 2015;115(8):1299-1307.e2.
22 Chriqui 2013 - Chriqui JF, Turner L, Taber DR, et al. Association between district and state policies and U.S. public elementary school competitive food and beverage environments. The Journal of the American Medical Association Pediatrics. 2013;167(8):714-722.
23 Fernandes 2013 - Fernandes MM. A national evaluation of the impact of state policies on competitive foods in schools. Journal of School Health. 2013; 83(4):249-255.
24 Taber 2012 - Taber DR, Chriqui JF, Perna FM, Powell LM, Chaloupka FJ. Weight status among adolescents in states that govern competitive food nutrition content. Pediatrics. 2012;130(3):437-444.
25 Sanchez-Vaznaugh 2010 - Sanchez-Vaznaugh EV, Sánchez BN, Baek J, Crawford PB. 'Competitive' food and beverage policies: Are they influencing childhood overweight trends? Health Affairs. 2010;29(3):436-46.
26 Van Hook 2012 - Van Hook J, Altman CE. Competitive food sales in schools and childhood obesity: A longitudinal study. Sociology of Education. 2012;85(1):23-39.
27 Sanchez-Vaznaugh 2015 - Sanchez-Vaznaugh EV, Sánchez BN, Crawford PB, et al. Association between competitive food and beverage policies in elementary schools and childhood overweight/obesity trends. The Journal of the American Medical Association Pediatrics. 2015;169(5):e150781.
28 Long 2013 - Long MW, Luedicke J, Dorsey M, Fiore SS, Henderson KE. Impact of Connecticut legislation incentivizing elimination of unhealthy competitive foods on National School Lunch Program participation. American Journal of Public Health. 2013;103(7):e59-66.
29 USDA-Smart snacks tools - U.S. Department of Agriculture (USDA), Food and Nutrition Service. Tools for schools: Focusing on Smart Snacks.
Related What Works for Health Strategies
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