School meals provide nearly half of children's daily calories, making them critical to childhood health. School food policies aim to improve student health by shaping the school food environment. While this environmental influence is known, the impact of these policies, especially following the Healthy Hunger-Free Kids Act of 2010, has not recently been synthesized. This review searched PubMed, EMBASE, ERIC, and Cochrane databases, identifying 28 studies assessing school food policy on student health. Of these, 23 found positive health effects from competitive food policies, and 5 found mixed positive and neutral effects. No studies reported negative impacts. These findings suggest that competitive food policies are an effective and equitable strategy for improving health that school nurses can support. This review synthesizes the current evidence on competitive food policy to establish baseline evidence for the function of such policies to promote population health and find areas where further research would be useful.
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