Wisconsin Medical Journal 2005 • Volume 104, No. 5 WISCONSIN MEDICAL JOURNAL Competitive Food Initiatives in Schools and Overweight in Children: A Review of the Evidence Sarah Fox, MD; Amy Meinen, RD, CD; Mary Pesik, RD, CD ; Matthew Landis, MS; Patrick L. Remington, MD, MPH Doctor Fox is a first year resident in the University of Wisconsin (UW) Department of Family Medicine, Madison. This article was written while she was in her 4th year of medical school at UW- Madison. Ms Meinen and Ms Pesik are with the Nutrition and Physical Activity Program within the Bureau of Community Health Promotion at the Division of Public Health (DPH) in Madison, Wis. Mr Landis is a graduate student in the Department of Population Health Sciences at UW-Madison. Doctor Remington is a profes- sor in the Department of Population Health Sciences at the UW Medical School and director of the UW Population Health Institute. Please address correspondence to: Patrick Remington, MD, MPH, UW Population Health Institute, 610 N Walnut St, Madison, WI 53726; phone 608.263.1745. ABSTRACT Background: Recent research has shown significant in- creases in the rates of obesity in US adults and chil- dren. Despite the widespread discussion about child- hood overweight, relatively little discussion focuses on solutions. Methods: We reviewed the literature on school pro- grams and policies that address competitive foods— commonly called “junk” foods. These foods tend to be high in sugar or fat and provide minimal nutritive value. Results: Sugar-sweetened beverages such as sodas con- tribute to weight gain and poor nutrition among stu- dents—the average student consumes 31 pounds of sugar in these drinks annually. The sale of competitive foods in schools often competes with the more nutri- tious school lunch programs. With minimal federal and state policies addressing the sale of competitive foods, individual school districts in Wisconsin and elsewhere have explored various alternatives to improve school nutrition. The evidence suggests that these policies can be effective and at the same time increase food sale rev- enue. Conclusion: Communities may be able to improve childhood nutrition through school-based nutrition programs and policies that address the sale of competi- tive foods. INTRODUCTION Considerable attention has been focused on the in- creasing rates of overweight and associated co-mor- bidities among children in Wisconsin. While the causes of overweight in children are multifactorial and com- plex, diet is 1 of the major contributors. From 1989 to 1996, the typical child’s average daily caloric intake in the United States increased by 80-230 calories per day. 1 The reasons for this increase include an increase in portion size, a shift from low energy density foods to high energy density foods, an increase in snacking, and, most notably, an increase in sugar-sweetened beverage consumption (e.g., soda, sweetened fruit drinks, energy drinks). 2 Despite the widespread discussion about childhood overweight, relatively little discussion focuses on solu- tions. Health care professionals, who are potential key stakeholders, can become more effective by having an awareness of school programs and policies related to overweight. There are 2 aims in this paper: first, to re- view the potential contribution of school nutrition on increasing rates of overweight among children, and sec- ond, to outline school policies intended to improve diet and reduce the consumption of “competitive foods,” that is, those foods offered at school other than meals served through USDA’s school meal programs. These foods tend to be high in sugar or fat and provide mini- mal nutritive value. CONSUMPTION OF SUGAR-SWEETENED BEVERAGES Added sugar now accounts for 20% of total food energy in the average child’s diet; one third of this added sugar comes from sugar-sweetened beverages. 3 Between 56% and 85% of children drink at least one 8-oz serving of sugar-sweetened beverage a day, and the average child Wisconsin Medical Journal 2005 • Volume 104, No. 5 38 WISCONSIN MEDICAL JOURNAL