The montage near the end of the first act spoofs Bart's shots in the show's opening; additionally, Barney appears in place of the now-deceased Bleeding Gums Murphy, in the same spot where Murphy appeared.
One of the candies that Bart eats is named Cop Killaz.
This episode reveals that Bart is allergic to cauliflower (adding to the other food allergies he has: shrimp, butterscotch, and imitation butterscotch; the only non-food allergy he has is glow-in-the-dark monster makeup).
In the Itchy & Scratchy cartoon Kitty-Kill Condition, the medical questionnaire that Scratchy fills out asks "Have You Ever Been:" followed by a list of catastrophic events, all of which happened to Scratchy in previous Itchy & Scratchy episodes:
Bart is the second character to have a heart attack (as well as the first kid).
This episode originally aired on the same day as the previous episode, "Don't Fear the Roofer", which originally aired before this episode. This is the first time that two new episodes of the show aired on the same day.
The distance from Spangler's compound to the Simpson house is inconsistent. Earlier in the episode, it is only an hour drive. Later, as Homer and Tab are out on the highway, Tab wants to stop at a motel overnight. It could be that he was trying to hit on Homer.
When Dr. Hibbert shows Bart's radiograph, there is a switch under the image, but when Marge points to Bart's liver and says that it looks healthy, the switch is missing from the plate. When Dr. Hibbert tells Homer and Marge that Bart has to follow a program of strict diet and exercise, the switch is back on the plate.
The title of this episode is probably a spoof of the 1972 film The Heartbreak Kid starring Charles Grodin. It may also reference World Wrestling Entertainment (WWE) Superstar Shawn Michaels whose nickname is "The Heartbreak Kid".
The song Homer sings for change to the German students on vacation is "99 Luftballons" by Nena.
The song played during Bart's junkfood binge is "Yummy Yummy Yummy" by The Ohio Express.
The line "raged against the machine" is a reference to the political rap-rock band Rage Against the Machine.
Bart opens a package of candy, throws it in the air, and lets it fall down onto and around him, echoing the scene where Andy stands in the rain after his escape.
Bart's candy-tossing scene could also be considered a reference to the scene in Pleasantville where David stands in the rain and transforms from black-and-white to color.
Homer says (regarding the milkshakes from the festival), "They're melting", in a style reminiscent of The Wicked Witch of the West while dying in The Wizard of Oz.
This episode's storyline is likely a satire of the real-world problem of vending machines in schools (which was briefly mentioned in the 2004 Morgan Spurlock film Super Size Me). In fact, some states have made it illegal for public schools to sell junk food to students during school hours.
Marge suggests that the family "give those Germans das boot", a reference to the 1981 German film Das Boot.
When the Simpsons kick out the German students, one of them says they will go to Disneyland to "heap the scorn on Goofy".