This report provides updated results from one of the most comprehensive studies of health-related policies and practices in U.S. public middle and high schools to date, which was released in August 2011. The major findings and trends presented in this report describe issues relevant to childhood obesity for four school years, from 2006-07 to 2009-10. The authors examine foods and beverages offered through the National School Lunch Program and outside of school meal programs, including those sold in vending machines, school stores and a la carte cafeteria lines. They also examine physical education requirements and rates of participation; participation in varsity and intramural sports; and walking and bicycling to and from school. This report offers timely insights for the U.S. Department of Agriculture (USDA) to consider as it continues implementation of the Healthy, Hunger-Free Kids Act of 2010. The report also helps inform future policies that aim to prevent obesity and improve children's diets, physical activity levels and overall health. Since their study began in 2007, there have been some improvements in the nutrition environment of U.S. public secondary schools. Many schools have been making an effort to offer students healthier foods and beverages for lunch and to provide healthier options in competitive venues, such as vending machines, school stores and a la carte cafeteria lines. Yet, most students still had easy access to pizza, french fries, sugary drinks and junk foods. This report highlights a number of conditions in middle and high schools that may be contributing to disparities across socioeconomic levels and across the racial and ethnic groups served. (Contains 6 figures, 2 tables, and 9 footnotes.)