    School Meal Programs: Competitive Foods Are Available in Many
    Schools; Actions Taken to Restrict Them Differ by State and
    Locality (23-APR-04, GAO-04-673).

    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?
    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-04-673
        ACCNO:   A09841
      TITLE:     School Meal Programs: Competitive Foods Are Available in
    Many Schools; Actions Taken to Restrict Them Differ by State and
    Locality
         DATE:   04/23/2004
      SUBJECT:   Children
    	     Food programs for children
    	     Health hazards
    	     Health statistics
    	     Schools
    	     Nutrition
    	     National School Breakfast Program
    	     National School Lunch Program

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    GAO-04-673

    United States General Accounting Office

    GAO

                           Report to Congressional Requesters

    April 2004

    SCHOOL MEAL PROGRAMS

    Competitive Foods Are Available in Many Schools; Actions Taken to Restrict Them
                              Differ by State and Locality

    GAO-04-673

    Contents

                                        Letter 1

      Appendix I Briefing Slides

    Abbreviations

    CDC Centers for Disease Control and Prevention
    FMNV foods of minimal nutritional value
    FNS Food and Nutrition Service
    SHPPS School Health Policies and Programs Study
    SMI School Meals Implementation
    SNDA-II School Nutrition Dietary Assessment Study-II
    USDA United States Department of Agriculture

    This is a work of the U.S. government and is not subject to copyright
    protection in the United States. It may be reproduced and distributed in
    its entirety without further permission from GAO. However, because this
    work may contain copyrighted images or other material, permission from the
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    separately.

    United States General Accounting Office Washington, DC 20548

    April 23, 2004

    The Honorable Tom Harkin
    Ranking Member
    Committee on Agriculture, Nutrition, and Forestry
    United States Senate

    The Honorable Patrick J. Leahy
    Ranking Member
    Subcommittee on Research, Nutrition, and General Legislation
    Committee on Agriculture, Nutrition, and Forestry
    United States Senate

    The Honorable George Miller
    Ranking Member
    Committee on Education and the Workforce
    House of Representatives

    The Honorable Lynn Woolsey
    Ranking Member
    Subcommittee on Education Reform
    Committee on Education and the Workforce
    House of Representatives

    The nation faces a complex challenge in addressing recent trends in
    children's health and eating habits. Data from the U.S. Centers for
    Disease
    Control and Prevention (CDC) have shown that over 15 percent of
    children and adolescents ages 6 to 19 are overweight, a proportion that
    has
    significantly increased since the 1960s. In addition, CDC has also
    reported
    an increase in the frequency of type 2 diabetes in U.S. children and
    adolescents over the last two decades. Trends in obesity and a low level
    of
    physical activity among children and adolescents may be a major
    contributor to this increase.

    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. Since a large portion of a child's day is spent in school,
    providing
    children with healthy food options throughout the school day can be an
    important step toward good child nutrition. 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 your concern about the trends in children's health and eating
    habits and your interest in further understanding issues related to
    competitive foods in schools, you 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?

    To answer your questions, we reviewed a variety of data sources, including
    legislation, policies, and studies that address competitive foods in
    schools. From these sources, we gathered information on federal and state
    competitive foods laws and regulations. In addition, we analyzed data on
    the availability, prevalence, and types of competitive foods in schools
    provided in three national studies-the School Nutrition Dietary Assessment
    Study-II, the School Health Policies and Programs Study of 2000, and the
    Third Year Report of the School Meals Initiative Implementation Study. We
    also reviewed several smaller-scale studies that address the association
    between competitive foods in schools and child nutrition. We examined each
    study to assess the adequacy of the samples and measures employed, the
    reasonableness and rigor of the statistical techniques, and the validity
    of the results that were drawn from the analyses. To supplement the
    information collected from these sources and to gather information on
    steps that have been taken at the local level to restrict competitive
    foods in schools, we conducted interviews with

    several professional organizations, advocacy groups, and other
    stakeholders. We conducted our review from January through March 2004 in
    accordance with generally accepted government auditing standards.

    On April 12, 2004, we briefed interested Senate staff on the results of
    our analysis. This report formally conveys the information provided during
    that briefing. In summary, we reported that

    o  	Competitive foods include all foods and beverages sold in schools
    except for meals provided through the School Lunch and School Breakfast
    Programs. Current federal regulations restrict only a subset of
    competitive foods, foods of minimal nutritional value, from being sold
    during mealtimes in food service areas.

    o  	Competitive foods are sold in a variety of locations on a majority of
    school campuses nationwide. The types of competitive foods available often
    differ by location where they are sold, with healthy foods more often sold
    in a la carte lines in the cafeteria and less healthy foods more often
    sold through vending machines, school stores, canteens, and snack bars.

    o  	Several states, school districts, and individual schools have enacted
    competitive foods policies that are more restrictive than federal
    regulations. These policies differ widely in the types of restrictions
    they apply.

    We provided a draft of this briefing to officials at FNS for their
    technical comments and incorporated their comments where appropriate.

    We are sending copies of this report to relevant congressional committees
    and other interested parties and will make copies available to others upon
    request. In addition, this report will be available on GAO's Web site at
    http://www.gao.gov. If you or your staff have any questions about this
    report, please contact me at (415) 904-2272 or Kay E. Brown at (202)
    5123674. Rachel Weber, Kevin Jackson, and Dan Schwimer also made
    significant contributions to this report.

    David D. Bellis Director, Education, Workforce, and Income Security Issues

                              Appendix I: Briefing Slides

     School Meal Programs: Competitive Foods Are Available in Many Schools; Actions
                  Taken to Restrict Them Differ by State and Locality

                                      Requested by
                           Senator Tom Harkin, Ranking Member
             U.S. Senate Committee on Agriculture, Nutrition, and Forestry
                         Senator Patrick Leahy, Ranking Member
              Subcommittee on Research, Nutrition, and General Legislation

                      Representative George Miller, Ranking Member
                  U.S. House Committee on Education and the Workforce
                      Representative Lynn Woolsey, Ranking Member
                            Subcommittee on Education Reform
                                     April 12, 2004

    Related GAO Products

    School Lunch Program: Efforts Needed to Improve Nutrition and Encourage
    Healthy Eating. GAO-03-506. Washington, D.C.: May 9, 2003.

    School Meal Programs: Revenue and Expense Information from Selected
    States. GAO-03-569. Washington, D.C.: May 9, 2003.

    Public Education: Commercial Activities in Schools. GAO/HEHS-00-156.
    Washington, D.C.: September 8, 2000.

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