Background: School-based interventions hold promise for child obesity prevention. Implemented as a part of the "Winning with Wellness" obesity prevention project, the "Go Slow Whoa" meal pattern (GSW) was designed to promote healthier foods in school cafeterias. This investigation determined perceived program effectiveness and impact on student's food purchases. Methods: A mixed method design was used, including focus groups with cafeteria staff (CS), quantitative analysis of CS and teacher surveys, and pre-post analysis of cafeteria sales. A total of 37 CS and 131 teachers from 7 schools in northeast Tennessee participated. Results: CS recognized the important role of school nutrition services in influencing student choices, yet perceived lack of administrative support for cafeteria-based interventions and minimal interaction with teachers were barriers. CS also believed that students choose less nutritious options due to family influence. Cafeteria sales indicated that changes were made in menu planning and production, yet students' choices improved minimally. Teachers expressed moderate levels of confidence in GSW as influential in children's dietary habits. Conclusions: Successful implementation of school-based nutrition programs requires supportive policies, administrators, and teachers. CS should be included in program implementation efforts and the role of school nutrition services should be maximized. (Contains 3 tables.)