Promoting Water Consumption in Schools to Prevent Overweight

The goal of this intervention trial was to prevent overweight by promoting water intake. The Research Institute of Child Nutrition, Dortmund, facilitated this joint environmental and educational intervention on elementary students. Promoting Water Consumption targeted second- and third-graders of German elementary schools from urban, deprived areas and lasted for one academic year. Schools represent an “ideal setting” for teaching healthy behaviors and “implementing innovative programs that focus on improving the nutrition” of students. The investigators were especially interested in intervening in deprived areas because there is a disparity that exists where prevalence levels of overweight children are much higher among children with low socioeconomic status. Structured as a randomized, control cluster trial, investigators selected the neighboring cities, Dortmund and Essen, using Dortmund elementary schools as the intervention group and Essen elementary schools as the control group. A primary intervention consisting of an educational portion and an environmental portion that included installing water fountains, providing students with water bottles, and preparing teachers with four 45-minute lessons on the importance of water in the intervention group.

To promote water consumption with an educational and environmental intervention in elementary schools of deprived urban areas to prevent overweight.

This program shows that environmental and educational, school-based interventions can have effective impact in the prevention of overweight among children in elementary school, even in a population from socially-deprived areas.

This randomized, control cluster trial used 32 elementary schools in two neighboring, socially deprived German cities. 17 schools were randomly assigned to the intervention while 15 were used as control schools. Specifically, a total of 2950 students (intervention group, N=1641; control group, N=1309) participated in the study. The key aspects measured in the study were body weight status and amount of beverages consumed. Body weight status was assessed in two categories: risk of overweight and BMI standard deviation score (SDS). Risk of overweight at follow-up assessment was significantly reduced when compared to control group with an OR of 0.69 (95% CI: 0.48-0.98; p-value = 0.04), yielding a 31% reduction in the intervention group. Additionally, BMI SDS changed by -0.004 (95% CI: -0.045 to 0.036; p-value = 0.829) with adjustment for BMI SDS at baseline, yet this change lacked statistical significance. Beverage consumption was assessed in three categories: glasses of water, juice, and soft drinks consumed per day. The intervention group consumed about 1.1 more glasses of water per day when compared to control group (95% CI: 0.7-1.4 glasses per day; p-value < 0.001). Additionally, juice consumption decreased in the intervention group by -0.2 glasses per day (95% CI: -0.4 to 0.0 glasses per day; p-value = 0.039), with adjustment for migrational background. When adjusting for baseline juice consumption, the intervention group consumed about -0.1 glasses per day (95% CI: -0.2 to 0.1 glasses per day; p-value = 0.5). However this finding was not statistically significant. Lastly, there was no intervention effect on soft drink consumption (p-value = 0.406).