The Five Most Unhealthful School Lunches

The Physicians Committee

Download this fact sheetThe Five Most Unhealthful School Lunches


A Report by the Physicians Committee for Responsible Medicine
Spring 2010



Because American children consume more than 7 billion school meals every year, the Physicians Committee for Responsible Medicine (PCRM) evaluates meals served in the National School Lunch Program and offers ideas for improving school nutrition. This year, as Congress considers making changes to school nutrition programs, PCRM dietitians analyzed lunch menus from 18 elementary schools across the country to determine which commonly served meals may be putting children’s health at risk and which healthful school meals should be offered more often.


PCRM dietitians found that many schools are still serving meals too high in saturated fat, but they also found that some schools are featuring healthful options that could be offered more frequently to improve menus and ensure that children have nutritious options to choose from every day of the week.

After reviewing nutrient analysis data from 18 schools, PCRM dietitians found that schools can meet targets for saturated fat and other nutrients by limiting or avoiding a few commonly served items. Most meals surveyed provided more than enough protein and adequate amounts of most micronutrients, but many items were high in saturated fat and calories, while providing little fiber. The five worst school lunches are ranked below, from worst to least bad.



Worst School Lunch Items

Disturbing Nutritional Facts


Beef and Cheese Nachos

24 grams of fat and almost 1,500 milligrams of sodium

Second Worst

Meatloaf and Potatoes

472 calories and 78 milligrams of cholesterol

Third Worst


More saturated fat than a child should consume in an entire meal

Fourth Worst

Cheese Sandwiches, including toasted cheese and cheese quesadilla

More than 7 grams of saturated fat and almost 1,000 milligrams of sodium

Fifth Worst

Pepperoni Pizza

More than 6 grams of saturated fat; pepperoni is a processed meat that increases cancer risk



Obesity, type 2 diabetes, high blood pressure, and abnormal cholesterol levels among children are all symptoms of a widespread problem: poor eating habits. One of the most powerful approaches to improving public health is to teach young people healthful eating habits early in life—in school lunch lines. Just as students learn to read, interact with peers, and relate with teachers, they also learn about what they should be eating while in the school environment.

The National School Lunch Program was created in 1946 with the passage of the National School Lunch Act. The program now serves more than 31 million American children. Schools participating in the program receive cash subsidies and commodity foods from the U.S. Department of Agriculture (USDA) for each meal served. In return, participating schools must serve lunches that meet federal nutrition requirements.

In 2007, the USDA’s analysis of school food showed that almost all schools served too much saturated fat to comply with the government’s requirements. Some of our nation’s schools offer healthful items in their lunch lines, but these healthier options are often overshadowed by high-fat, high-calorie options.

The Institute of Medicine (IOM) issued a report in 2009 recommending that schools serve more fruits, vegetables, and whole grains, while reducing saturated fat and sodium. But the recent economic downturn has increased the number of students who rely on school lunches, making it even more difficult for schools to provide healthful meal options for students.

The Child Nutrition Act, which helps determine what foods are served in schools and how schools are compensated, is before Congress for reauthorization. The Senate version of revisions to the bill has already been introduced, and it encourages schools to follow the IOM’s recommendations.

As legislators and regulators raise school meal standards, schools will need innovation and support to improve meal quality. By replacing menu items high in saturated fat with low-fat, plant-based options, schools can meet federal guidelines and help teach students healthful eating habits early in life.

Review Process

In March 2010, dietitians with PCRM collected nutrient analysis data from school districts across the country. They collected and analyzed 18 elementary school menus, representing rural, urban, and suburban districts in all regions of the continental United States.

The dietitians calculated average nutrition information for each menu item offered. For example, five of the districts surveyed offered sloppy joes. Researchers averaged the nutrition information from those five districts to estimate the nutrient profile of a typical sloppy joe. The five items most frequently offered were: (1) chicken nuggets and chicken tenders, (2) hot dogs, (3) cheese pizza, (4) deli sandwiches, and (5) hamburgers.

Dietitians obtained nutrition information by reviewing analyses available on school district Web sites. They used a point system to evaluate the averages for each menu item based on key nutritional data, including the item’s calories, total fat, saturated fat, cholesterol, sodium, and fiber. They compared each item’s nutrient information with the government’s nutrient targets for kindergarten through sixth grade (see below). Ratings also reflect whether the product is categorized as junk food. Junk food items such as burgers, pizza, chicken nuggets, hot dogs, and nachos were examples of junk foods.

Note about sodium: In general, all manufacturers will have to dramatically reduce sodium to meet IOM recommendations. This will be a huge challenge for schools across the board.


Energy allowance (calories)           


Total fat (grams)


≤22 (30 percent of total calories)

Saturated fat (grams)    

≤7 (10 percent of total calories)

Protein (grams)     


Calcium (milligrams) 


Iron (milligrams)   


Vitamin A (RE)   


Vitamin C (milligrams)     


The required components: meat/meat alternate, bread, fruits/vegetables, and milk.


Detailed Results: Five Worst School Lunches

Beef and Cheese Nachos
Rank: Worst School Lunch Item
This menu item was ranked the worst because its average nutrient content is among the highest for calories (469), sodium (almost 1,500 milligrams), total fat (24 grams), and saturated fat (8.8 grams). Further, this one menu item alone exceeds the limits for total and saturated fat allotted for the entire meal. (Those limits are set at 22 grams of total fat and 7 grams of saturated fat.) High-calorie entrées, such as this one, are paired with side items and beverages, which range from healthful choices, such as steamed broccoli, to chocolate milk, which has more than 150 calories.

Meatloaf and Potatoes
Rank: Second-Worst School Lunch Item
It’s time to rethink this traditional American meal. This main course provides 472 calories, 78 milligrams of cholesterol, more than 1,000 milligrams of sodium, and more total fat (26.4 grams) and saturated fat (10.5 grams) than elementary students should consume in the entire meal.

Rank: Third-Worst School Lunch Item
This frequently appearing menu item has nutrient averages among the highest for calories (401), cholesterol (54 milligrams), total fat (19 grams), and saturated fat (7.6 grams). Like the first and second worst items, cheeseburger saturated fat averages exceed the recommended limit on saturated fat for the whole meal.

Cheese Sandwiches
Rank: Fourth-Worst School Lunch Item
One unexpected result of the survey: Cheese sandwiches—grilled cheese, toasted cheese on wheat, and cheese quesadillas—provide enough saturated fat to rival a cheeseburger. This deceptively unhealthy menu item may sound like a good choice to picky eaters, but researchers found that cheese sandwiches pack in the saturated fat (7.1 grams) and have little fiber. Because cheese tends to contain high amounts of sodium, cheese sandwich averages approach 1,000 milligrams per serving.

Pepperoni Pizza
Rank: Fifth-Worst School Lunch Item
This menu item’s averages for total fat (14.4 grams) and saturated fat (6.3 grams) are among the highest. These numbers remain high, despite many school districts’ use of reduced-fat meat and cheese and whole grain crust.

Healthy, High-Fiber Options
About one-third of schools surveyed offered a low-fat, high-fiber vegetarian option on at least one of the menu days. Many more schools offered cheese sandwiches, macaroni and cheese, and other cheese-based vegetarian options, but these high saturated fat, low-fiber items did not stand up to the nutrient profiles of entirely plant-based choices.  

To help schools identify healthful alternatives to the higher saturated fat items, five items were selected that would most improve nutrient intake. Items lowest in saturated fat and highest in fiber were selected. Items were given preference if they included some fruits or vegetables and met USDA protein requirements.

Five Healthful Options



Healthiest School Lunch Items


Vegetarian Chili

Second Healthiest

Veggie Burger


Beans and Rice


Hummus with Pita


Whole Grain Pasta with Marinara or Primavera Sauce


Vegetarian Chili
Rank: Healthiest School Lunch Item
This low-cost menu item has almost no saturated fat and about 7 grams of fiber. Schools can add their choice of seasonal veggies or healthful USDA commodity produce to veggie chili. There was a variety of sodium levels among vegetarian chilis, and schools should be careful to select the lower-sodium versions.

Veggie Burger
Rank: Second-Healthiest School Lunch Item
Veggie burgers are kid-friendly favorites that can easily be added to a heat-and-serve kitchen as well as cooking kitchens. Without added cheese, this item averaged 262 calories, no cholesterol, 5.8 grams of fiber, 15.9 grams of protein, 5.7 grams of total fat, and 0.7 grams of saturated fat. Veggie burgers tend to be higher in protein, and they easily surpass the 10 gram benchmark for elementary school lunches.

Beans and Rice
Rank: Third-Healthiest School Lunch Item
Rice and beans is an economical menu item that can be spiced up to please the pickiest eaters. This item received points for being a high-fiber, low-fat source of protein. By adding sautéed veggies or salsa, schools could include more veggies in this healthful dish.

Hummus with Pita
Rank: Fourth-Healthiest School Lunch Item
Hummus is gaining popularity among students. This option ranked below the veggie chili, veggie burger, and beans and rice because it tends to be higher in fat than other plant-based options. However, hummus averages for total fat (10.4 grams) were still well below the 22 gram limit for elementary schools, and saturated fat averages (2.6 grams) will help schools meet targets. Serving hummus along with carrots, celery, cucumbers, sugar snap peas, bell pepper strips, or other seasonal vegetables is a great way to introduce more fresh veggies.

Whole Grain Pasta with Marinara or Primavera
Rank: Fifth-Healthiest School Lunch Item
More and more schools are switching to whole grains—and that is great news for school children. Whole grain pasta with tomato sauce and vegetables makes a great low-fat option with extra veggies. The whole grains add extra fiber and the many health benefits packaged with it. This menu item ranked fifth because of the lower protein level. Pastas averaged 5 grams of protein per serving, which is half of the requirements. PCRM dietitians recommend adding white beans for a classic Italian-style dish or soy crumbles for a faux-meat-style dish without the saturated fat and cholesterol. These serving suggestions would easily add the few extra grams of protein to meet requirements.