Obesity: Increasing Water Access in Schools
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of interventions to increase water access in schools. Evidence is considered insufficient because there were too few studies.
The CPSTF recommends the following related interventions in school settings:
Healthy Eating Interventions Combined with Physical Activity Interventions
Healthy Eating Interventions Alone
- Meal or Fruit and Vegetable Snack Interventions to Increase Healthier Foods and Beverages Provided by Schools
- Multicomponent Interventions (Meal or Fruit and Vegetable Snack Interventions + Healthier Snack Foods and Beverages) to Increase Availability of Healthier Foods and Beverages in Schools
Physical Activity Interventions
The CPSTF finds insufficient evidence for two other intervention approaches that focus on healthy eating in schools alone and two other intervention approaches that focus on healthy eating combined with physical activity in schools. Read a summary of the findings from all eight reviews of school-based interventions to prevent obesity.
The full CPSTF Finding and Rationale Statement and supporting documents for Obesity Prevention and Control: Interventions to Support Healthier Foods and Beverages in Schools are available in The Community Guide Collection on CDC Stacks.
Intervention
Interventions to increase water access in schools ensure students have access to safe, free drinking water during the school day. Interventions may include one or more of the following:
- Procedures to ensure water fountains are clean and maintained
- Availability of water fountains and hydration stations throughout the school
- Policies allowing students to have water bottles in class
Interventions may also include healthy eating learning opportunities, such as nutrition education and other strategies that give children knowledge and skills to help choose and consume healthier foods and beverages.
About The Systematic Review
In 2013, the Agency for Healthcare Research and Quality (AHRQ) conducted a meta-analysis on the effectiveness of childhood obesity prevention programs implemented in 6 intervention settings. The CPSTF finding is based on a subset of studies from the review that focused on dietary-only approaches in schools (Wang et al., 2013; 15 studies, search period through August 2012) combined with more recent evidence (36 additional studies, search period August 2012 to January 2017).
Study Characteristics
- Study designs included group randomized trial (1 study) and repeat cross-sectional with concurrent comparison group (1 study).
- Studies were conducted in the United States (1 study) and Germany (1 study).
- Both studies evaluated interventions conducted in schools alone.
- One study was implemented in elementary and middle schools and 1 study was implemented in an elementary school only.
- Both studies were set in urban areas.
- One study was implemented in a lower socioeconomic population.
Summary of Results
The systematic review included 2 studies.
Weight-Related Outcomes
- Overweight/Obesity Prevalence significant decrease (1 study)
- The risk of overweight was significantly reduced in the intervention group compared to the control group (1 study)
Diet-Related Outcomes
- Sugar-sweetened beverage intake no intervention effect (1 study)
- Water intake significant increase of 1.1 glasses per day; p<0.001 (1 study)
- Fruit juice intake decrease of 0.1 glasses per day (1 study)
Summary of Economic Evidence
An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.
Applicability
Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.
Evidence Gaps
- Which intervention activities, such as allowing water bottles in class, adding water fountains or dispensers, or combinations of these activities are most effective? Which activities are critical to success?
- What are the cumulative effects of adding intervention components? Is a single component equally effective?
- In order to increase comparability what are the “best measures” for dietary intake outcomes?
- Do children act as agents of change by discussing changes in the school environment with parents? Do parents incorporate healthier dietary habits at home?
- How often do schools implement interventions with fidelity? What amount of training is needed for faculty?
- Does effectiveness vary by age group?
- Are national, state, or local policies most effective?
- Approximately half of the studies reported on weight outcomes; future studies should report weight-related outcomes to increase understanding of intervention effectiveness.
- For studies reporting on milk products and alternatives to dairy, what is the fat content of these foods and beverages?
- Do interventions lead to other health benefits such as improvements in cholesterol or blood pressure?
Implementation Considerations and Resources
The CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.
Crosswalks
Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)