State-Level Promotion of Plant-Based School Meals in the United States: A National Policy Review

Background: Pediatric cardiometabolic health in the United States is declining, driven by rising rates of obesity, prediabetes, and type 2 diabetes. School lunch programs provide a unique opportunity to influence children's dietary behaviors, reaching millions of students across diverse socioeconomic backgrounds each day. Increasing the availability of plant-based meals in school lunch programs may help reduce modifiable cardiometabolic risk factors and serve as a cost-effective, population-level strategy to promote long-term cardiovascular health. Methods: We conducted a cross-sectional narrative policy review of school lunch programs across all 50 U.S. states and the District of Columbia. Publicly available state statutes, regulations, school nutrition guidance, government reports, and educational resources were systematically reviewed to identify official statewide policies or guidance explicitly supporting plant-based or vegetarian meals. Jurisdictions were classified as providing either Explicit Support or Not Specified according to predefined coding criteria. We also assessed whether jurisdictions specified the frequency of plant-based meal offerings. Results: Only 3 of 51 jurisdictions (5.9%)-California, the District of Columbia, and Illinois-provided explicit statewide support for plant-based meal options. The remaining 48 jurisdictions (94.1%) did not explicitly promote or support plant-based meals in official statewide school nutrition policies or guidance. No jurisdiction mandated the frequency of plant-based meal offerings, although the District of Columbia provided non-binding guidance encouraging regular inclusion. Conclusions: Explicit statewide support for plant-based or vegetarian school meals remains rare in the United States. Strengthening state-level policies and developing standardized guidance on the inclusion and frequency of plant-based meals in school lunch programs may represent a feasible population-level strategy to improve dietary quality and reduce future pediatric cardiometabolic risk.