Sara N. Bleich

Policy Points: Federal nutrition assistance swung from expansion during the Biden administration to significant contraction during the first year of the Trump administration. These changes may undermine the Trump administration's goal to Make America Healthy Again and may have implications for food insecurity, diet‐related disease, and health inequities. Rigorous, ongoing evaluation will be essential to assess these impacts and inform future policy decisions. Context: From 2021 to 2025, federal nutrition assistance policy in the United States shifted rapidly from expansion to contraction, with major implications for food insecurity, diet quality, and chronic disease risk. Methods: Qualitative policy analysis based on a targeted review of federal legislation, regulations, agency guidance, and white papers related to nutrition assistance programs was used to systematically identify and compare major shifts in program scope, design, and implementation. Findings: From 2021 to 2024, Congress and the US Department of Agriculture's Food and Nutrition Service (FNS) expanded and modernized federal nutrition programs, elevated the concept of nutrition security, and invested in administrative capacity. Key actions included increasing Supplemental Nutrition Assistance Program (SNAP) benefits, updating Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and school meal standards to align with the 2020‐2025 Dietary Guidelines for Americans , expanding child nutrition programs (e.g., SUN Bucks, community eligibility), and strengthening FNS staffing. In 2025, the second Trump administration and a Republican‐controlled Congress reversed course. HR 1 enacted historic SNAP cuts, expanded work‐related time limits, shifted costs to states, eliminated SNAP‐Ed, and restricted access for some immigrants, while collateral reductions affected WIC, emergency food programs, and other supports. Additional Trump‐era actions weakened the scientific basis of the 2025‐2030 Dietary Guidelines for Americans , introduced new retailer standards and product restrictions, canceled the Household Food Security Report, and reduced the FNS workforce. Conclusion: Recent policy shifts threaten to increase food insecurity and exacerbate inequities. These efforts appear misaligned with Make America Healthy Again's stated focus on improving diet quality and reducing childhood chronic disease. Rigorous, ongoing evaluation of the impacts of these changes on participation, diet quality, food insecurity, and health—particularly among historically underserved populations—is essential to guide future federal nutrition policy.

The calorie menu labeling provision of the 2010 Patient Protection and Affordable Care Act (P.L. 111-148) requires food establishments with 20 or more US locations to post the calorie content of prepared foods on menus alongside the item’s price.¹ The goals of the policy, enforced as of May 2018, are to encourage customers to purchase lower-calorie foods (change what consumers demand) and to prompt retailers to offer lower-calorie options (change what restaurants supply). Most evaluations of this policy have examined changes in consumer behavior,^2-8 with the studies with the largest samples finding 4% to 6% reductions in calories purchased after labeling.^7,8

The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.

Background: Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus.Methods and findings: We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of −54 calories/transaction (95% confidence interval [CI]: −67, −42,p< 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1,p< 0.0001). Nationwide implementation was associated with a level decrease of −82 calories/transaction (95% CI: −88, −76,p< 0.0001) and a subsequent −2.1 calories/transaction decrease per 4-week period (95% CI: −2.9, −1.3,p< 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = −73 calories/transaction, 95% CI: −81, −65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data.Conclusions: In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants.

Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.