Health Impact Assessment: National Nutrition Standards for Snack and a la Carte Foods and Beverages

The Kids’ Safe & Healthful Foods Project and the Health Impact Project, both collaborations of The Pew Charitable Trusts and the Robert Wood Johnson Foundation, working in collaboration with Upstream Public Health

The 2010 Healthy, Hunger-Free Kids Act directed the U.S. Department of Agriculture (USDA) to align nutrition standards for all foods and beverages sold in schools with the federal dietary guidelines. Healthy diets are linked to a number of children’s health outcomes, including maintaining a recommended weight, decreased risk of tooth decay and other chronic diseases, and improved school performance.

Vulnerable populations, including low-income, black, and Hispanic students, have a higher likelihood of being overweight or obese; suffer from hypertension, Type 2 diabetes, or other chronic illnesses; and have limited or uncertain access to adequate food. These and other nutrition-related issues can reduce quality of life, increase absence from school, and lead to longer-term health problems.

In addition to their critical role in student nutrition, food sales make up an important component of school budgets, and student purchases of snack foods outside of regular meal service, such as from vending machines, often generate revenue that pays for other school programs that benefit student health, such as enrichment learning and opportunities for physical activity.

In an effort to inform USDA’s update of school nutrition standards, the Kids’ Safe and Healthful Foods Project along with the Health Impact Project—both collaborations between the Robert Wood Johnson Foundation and The Pew Charitable Trusts—worked with Upstream Public Health, a nonprofit research and policy organization, to conduct an HIA of potential health impacts of the proposed changes on students’ school-based diets, health outcomes, and school food service revenue.

The assessment concluded that updating national nutrition standards for snack foods and beverages sold in schools could help students maintain a healthy weight without decreasing revenue. Specific key findings from the HIA included:

  • Many students consume as many as half of their daily calories at school, and changing the nutrition standards could have a dramatic effect on overall health.
  • Changes to the types of food offered, such as replacing candy bars and pastries with more fruits and vegetables, may reduce the risk of many negative health issues, including tooth decay, obesity, and other chronic diseases.
  • Changing snack foods and beverage policies tends to increase student participation in school meal programs and could improve overall nutrition as more students purchase meals in place of less healthy snack options.
  • The shift in student purchases from snack and a la carte foods to school meals generally leads to stable or even increased school food service revenue.
  • Strong nutrition standards are particularly beneficial for vulnerable student populations. Updating nutrition guidelines could have positive impacts on indicators of academic success, especially among low-income, black, and Hispanic students.

Based on those findings, the Kids’ Safe and Healthful Foods Project worked with stakeholders to develop recommendations for the implementation of the updated standards to maximize health benefits and minimize risks. Specifically, USDA should establish nutrition standards for:

  1. All foods sold regularly on school grounds outside of the school meal programs. Schools should select items from the Dietary Guidelines for Americans (DGA) list of “foods to encourage,” use age-appropriate caloric limits for items sold individually, limit the percentage of total calories from sugar and fats, and incrementally reduce sodium to achieve alignment with the DGA.
  2. All beverages sold on school grounds. USDA should limit beverages sold in elementary and middle schools to water, low-fat and fat-free milk, and 100 percent fruit juice in appropriate portions to minimize calories obtained from sugar-sweetened beverages.
  3. USDA should adopt policies and practices that ensure effective implementation of the standards, such as offering technical assistance and training to schools and districts, providing clear guidance on terms, keeping nutrition standards up-to-date with the DGA, and collaborating with states and nongovernmental organizations on monitoring.


This was the first HIA to inform a federal rule-making process. USDA incorporated nearly all of the recommendations into the interim-final rule and noted that the HIA added new information to the process by addressing a key district concern: food service revenue. USDA highlighted the importance of the HIA to the agency’s Regulatory Impact Assessment (RIA), calling it “recent, comprehensive, and groundbreaking.” The new standards went into effect in fall 2014 and are being implemented in all U.S. schools that participate in the school meal programs.

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At A Glance

Completion Date
2012, June
Agriculture, Food and Drug
Organization Type