The nation faces a complex challenge in addressing recent trends in children's health and eating habits. To address these trends, in 2001, the U.S. Surgeon General issued a call to action to prevent and decrease overweight and obesity among all Americans, especially children. In this statement, schools were identified as one of the key settings for public health strategies to address these issues. The National School Lunch and School Breakfast Programs provide millions of children with nutritious meals each school day. The United States Department of Agriculture's (USDA) Food and Nutrition Service (FNS) administers these programs at the federal level, and FNS subsidizes the meals served through these programs in local schools as long as the meals meet certain nutritional guidelines. In the last decade, these nutritional guidelines were amended to require schools to serve meals that adhere to the Dietary Guidelines for Americans, which limit total and saturated fat and provide specific minimum levels of vitamins and nutrients. Despite these efforts to improve the nutritional quality of meals offered through the school meal programs, other foods not provided through these programs are often available to children at school through a la carte lines in the cafeteria where individual foods and beverages can be purchased, snack shops, school stores, vending machines, and other venues. The nutritional value of these foods, often referred to as competitive foods, is largely unregulated by the federal government. Because of its concern about the trends in children's health and eating habits and interest in further understanding issues related to competitive foods in schools, Congress asked us to answer the following questions: (1) Which foods and school food practices fall under the term competitive foods, and what federal restrictions exist on their sale? (2) What is currently known about the types of competitive foods and their availability and prevalence in schools? (3) What is currently known about additional steps that are being taken on the state and local levels to curtail the sale of competitive foods?
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