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School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias. From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.

Despite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Although obesity is acknowledged as a complex issue, many debates about its causes and solutions are centred around overly simple dichotomies that present seemingly competing perspectives. Examples of such dichotomies explored in this Series include personal versus collective responsibilities for actions, supply versus demand-type explanations for consumption of unhealthy food, government regulation versus industry self-regulation, top-down versus bottom-up drivers for change, treatment versus prevention priorities, and a focus on undernutrition versus overnutrition. We also explore the dichotomy of individual versus environmental drivers of obesity and conclude that people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest. We propose a reframing of obesity that emphasises the reciprocal nature of the interaction between the environment and the individual. Today's food environments exploit people's biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods. This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments. Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles.

School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a “traffic light” approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial.

Threatened by possible government regulation and critical public opinion, industries often undertake self-regulatory actions, issue statements of concern for public welfare, and assert that self-regulation is sufficient to protect the public. The food industry has made highly visible pledges to curtail children's food marketing, sell fewer unhealthy products in schools, and label foods in responsible ways. Ceding regulation to industry carries opportunities but is highly risky. In some industries (e.g., tobacco), self-regulation has been an abject failure, but in others (e.g., forestry and marine fisheries), it has been more successful. We examined food industry self-regulation in the context of other self-regulatory successes and failures and defined 8 standards that should be met if self-regulation is to be effective.

School meals are a cornerstone of the United States’ nutrition safety net for children from low-income families, providing nearly 30 million lunches daily. However, recent U.S. policy actions may limit access to school meals for children who need them most. The One Big Beautiful Bill Act changed eligibility requirements to limit participation in the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. School-age children enrolled in SNAP and Medicaid are automatically enrolled in school meal programs. Limiting participation in SNAP and Medicaid has the potential to significantly impact children’s ability to receive nutritious school meals at low or no cost, will make it harder for schools to participate in community eligibility provision, and will increase the administrative burden on school staff and parents.

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition education (implementation of actions promoting healthy eating), food commercialization (healthiness index, number of unprocessed, minimally processed or processed foods and culinary preparations based on these foods—UMPCP; ultra-processed foods and culinary preparations based on these foods—UpCP; comparison of UMPCP versus UpCP variety; and prohibition of food sales), and marketing communication strategies (advertising strategies for UMPCP and UpCP). The presence and quality of municipal and state regulations in force up to the month prior to data collection were assessed using a score, with a score ≥8 indicating higher quality. Analyses were conducted using binary logistic regression and adjusted generalized linear models in Stata 17.0. More than half of the canteens (51.1%) were located in areas without regulations, and only 17.8% had high-quality regulations. Canteens in areas with regulations, especially those with a score ≥8, had 1.73 times higher odds of implementing food and nutrition education actions, 2.49 times higher odds of prohibiting the sale of certain foods, and 36% lower odds of selling a higher variety of UpCP compared to UMPCP. The healthiness index was higher, the number of UpCP sold was lower, and the number of UMPCP sold was higher, while the adoption of advertising strategies was less frequent in canteens with higher-quality regulations. These findings indicate that the presence and particularly the quality of regulatory measures is associated with healthier school food environments, highlighting the positive impact of well-structured public policies.

Background/Objectives: The purpose of this article (a comparative analysis of state laws) is to thoroughly examine enacted state-level healthy universal school meals bills to summarize bill content and determine current practices for program implementation and long-term viability, with special attention to the Community Eligibility Provision (CEP). Methods: Bills enacted at the state level, as of 31 December 2025, were located electronically on state legislature websites and subsequently reviewed with rules, regulations, and implementation guidelines. Content analyses were conducted to identify patterns, themes, and key concepts pertaining to healthy universal school meals laws and program implementation guidelines to inform comparison policy analyses. Results: Nine states (California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico, New York, and Vermont) have healthy universal school meals laws that include mandatory funding provisions for programming. Michigan is the only state that has a non-permanent law. Such laws eliminate requirements to certify individual students for free, reduced-price, or full-price meals based on their household income, and instead allow entire schools and/or school districts to offer all enrolled students no-cost meals. All states are funding healthy universal school meals programming by leveraging existing or new tax revenue to bridge the gap between the cost of school meals and federal meal reimbursements. Conclusions: State laws that leverage the Community Eligibility Provision (CEP) have become a key way to sustain universal school meal programs when federal funding falls short. States that direct resources to high-poverty schools, help districts determine the most accurate Identified Student Percentage, and reduce undercounting through strong direct-certification practices are better positioned to maintain universal meals over time. These strategies strengthen both child health and academic outcomes by ensuring stable access to no-cost, nutritious meals.

Background: The Healthy, Hunger-Free Kids Act was passed in 2010 to update nutrition standards in the National School Lunch and Breakfast Programs to be in accordance with evidence-based guidelines. In 2017 and 2020, the United States Department of Agriculture proposed flexibilities to the nutrition standards for milk, whole grains, and sodium. Objective: This study examines the positions used by stakeholders in support for or opposition to the proposed rules. Methods: We conducted a longitudinal qualitative content analysis of public comments posted to the U.S. Federal Register in response to the USDA’s proposed rules in 2017 and 2020. All public comments submitted by individuals and organizations were analyzed (n = 7323, 2017 and n = 2513, 2020). Results: Results indicated three categories of arguments: (1) comments favoring the original law, (2) comments favoring flexibilities, and (3) other. In both comment periods, constituents opposed the implementation of flexibilities, while schools and manufacturers/industry predominately supported them. Academic and advocacy organizations opposed the original proposed change (2017) but relaxed their position in 2020. Conclusions: Any flexibility to the required nutritional standards of school meals has the potential to affect the health trajectory of youth. It is imperative to understand how stakeholders view this issue and inform policy change.

Background: Food and Nutrition Security (FNS) policies in Brazil aim to ensure a broad spectrum of rights and were formulated based on the complex relationship among the State, Society, and Market in the capitalist order. The human right to adequate food (HRAF) is reflected in the guidelines of the National School Feeding Program (Programa Nacional de Alimentação Escolar—PNAE), which is implemented and monitored by the National Education Development Fund (Fundo Nacional de Desenvolvimento da Educação—FNDE). The PNAE consolidates part of the strategies adopted by the Brazilian State to combat hunger among children and adolescents and promote healthy habits by offering food in schools. However, there is no recent evaluation on the aspects of management, financing, and monitoring of the PNAE in the Brazilian Federal District. Objective: This study aims to contribute to the debate on health promotion and the right to adequate food by analyzing documents and legislation in force until 2024 related to the PNAE, as well as those that maintain a correlation with food and nutritional security policies in Brazil, verifying the scope and guarantee of rights and their applicability based on a critical analysis of the selected database. Methods: Brazilian official documents and legislation related to FNS and school meals were reviewed for inclusion in the database. The historical-dialectical materialist method was employed for content analysis, and the analyzed documents underwent a critical reading and the coding process, grouping common themes, utilizing MaxQda® software for support. Results: The word cloud (20 words) shows that the document groups emphasize food as a right, with 6038 occurrences found and relating to the “rights” approach with 2365 occurrences found, highlighting words related to FNS policies. Public actions to achieve health and food supply were expressed through the words “public” (381 occurrences) and “DHAA” (510 occurrences). The code cloud highlights social control as the most frequently attributed code in the set of documents, with 105 codified segments, indicating that democratic control and societal participation are crucial for achieving the PNAE’s objectives. Conclusions: The analyses underscored the importance of social control, as evidenced by the exploration of the research corpus and demonstrated in the code cloud. The role of monitoring and social control falls to the School Feeding Council (CAE), being the body responsible for verifying compliance with the Program’s objectives, enabling the adoption of timely measures to correct the PNAE’s course and contribute to achieving its objectives.

The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.