The Physicians Committee for Responsible Medicine has issued a report "The Five Most Unhealthful School Lunches."
Topping the list was beef and cheese nachos with 1,500 milligrams of sodium and 24 grams of fat.
The second worst was meatloaf and potatoes with 472 calories and 78 milligrams of cholesterol.
The third worst was a cheeseburger with more saturated fat than a child should have in an entire meal.
The fourth worst was cheese sandwiches with more than 7 grams of saturated fat and almost 1,000 milligrams of sodium.
The fifth worst was pepperoni pizza with more than 6 grams of saturated fat. Pepperoni, said the report, is a processed meat that increases cancer risk.
The report suggests that schools increase the number of days they serve healthier options and suggests items such as vegetarian chili and veggie burgers.
PCRM dietitians analyzed lunch menus and nutrition from 18 schools for the report.