Obesity Prevention and Control: Increasing Water Access Combined with Physical Activity Interventions in Schools

The CPSTF finding is based on evidence from a systematic review of one study (search period 1990 July 2017).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

While there are many approaches available to schools, this CPSTF finding focuses on interventions to increase water access with physical activity interventions. Read a summary of all CPSTF findings for school-based interventions to prevent or control obesity.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included one study.

The single study in this review reported a decrease in consumption of sugar-sweetened beverages, and an increase in the prevalence of overweight or obese.

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

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.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• Are these interventions effective?
• Do school-based interventions that increase water consumption also decrease sugar-sweetened beverage consumption?

• The included study was conducted in The Netherlands with students in grades 2 through 7.

Buchanan LR, Wethington HR, Finnie RKC, et al. A Community Guide systematic review: school dietary and physical activity interventions [PDF – 786 KB]. American Journal of Preventive Medicine 2023;64(3):441−51.

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Analytic Framework [PDF – 97 kB]

Effectiveness Review

Summary Evidence Table [PDF – 861 kB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

van de Gaar VM, Jansen W, van Grieken A, Borsboom GJJM, Kremers S, Raat H. Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2014;11:98.

Effectiveness Review

The following six bibliographic databases were searched between 1990 and July 2017, using the search terms listed below.

• PubMed
• Embase (Ovid)
• CINAHL
• PsycINFO (Ovid)
• Cochrane
• Medline (OVID)

The databases covered publications in medical and social sciences, behavioral sciences, and nursing and allied health. The types of documents retrieved by the search included journal articles, books, book chapters, reports, and conference papers.

Following are search strategies specific for Medline. Search terms and search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software.

Medline (OVID)

1. (school or schools or kindergarten*).ab,hw,ti.

2. (school cafeteria* or school provided or school located or school lunch* or school breakfast* or school week* or during school or school clinic* or school health or school setting* or “school nutrition” or “lunchroom” or lunchrooms or canteen* school intervention* or school environment* or school day or school hours or school provided or school located or school lunch* or school breakfast* or school week* or during school or school clinic* or school health or ‘in school’ or school based or on site or ‘at school’).mp.

3. (nutrition or diet or diets or dieting or vending machine* or candy or sweets or fruits or vegetables or vegetarian or vegan or sweetened drinks or sweetened beverages or soda or carbonated or low fat or gluten free or water or dietary or food or foods or pop or dessert* or cake or cookies or brownies or baked goods or carbohydrates or sugary or sugars or sugar or soft drink* or “Exercise” or “stair climbing” or “recess” or “volleyball” or “golf” or “golfing” or “yoga” or “pilates” or “baseball” or “gymnastics” or “gym” or “pe” or “physical education” or “playtime” or “movement” or “active living” or “play time” or “calisthenics” or jazzercise or “badminton” or “walk” or “walked” or “walking” or “jogging” or “jog” or “jogged” or “physical activity” or “physical activities” or “exercise” or “exercising” or “running” or “dance” or “dancing” or “aerobics” or “tennis” or “lacrosse” or “football” or “soccer” or weight lifting or weigh training or hand ball or handball or net ball or basketball or basket ball or netball or racket ball or racquet ball or horseback or roller skates or roller skating or skateboard* or skate board* or bicycle* or bicycling or cycling or sport or sports or school sports or walk or walking).mp.

4. (“Program Evaluation” or “benchmark” or “benchmarking” or “outcome” or “outcomes” or “program evaluation” or “evaluate” or “evaluated” or “evaluating” or “evaluation” or “improve” or “improvement” or “improvements” or “improving” or “improved” or “lessen” or “lessening” or “increase” or “increased” or “increasing” or “decrease” or “decreased” or “decreasing” or measur* or “weight” or “body mass” or “bmi” or “circumference” or consum* or “intake” or promot* or “add” or “added” or “additional” or “success” or “successes” or “successful” or “fitness”).mp

5. 1 AND 2 AND 3 AND 4

6. (“Afghanistan” or “Benin” or “Burkina Faso” or “Burundi” or “Central African Republic” or “Chad” or “Comoros” or “Congo” or “Eritrea” or “Ethiopia” or “Guinea” or “Haiti” or “North Korea” or “Liberia” or “Madagascar” or “Malawi” or “Mali” or “Mozambique” or “Nepal” or “Rwanda” or “Senegal” or “Sierra Leone” or “Somalia” or “South Sudan” or “Tanzania” or “Togo” or “Uganda” or “Zimbabwe” or “Gambia” or “Niger” or “Mexico” or “Guinea” or “Ecuador” or “Ecuador” or “Montenegro” or “Montenegro” or “Dominica” or “Dominica” or “Marshall Islands” or “Micronesia” or “Micronesia” or “Tuvalu” or “Dominican Republic” or “Mauritius” or “Mauritius” or “Venezuela” or “Venezuela” or “Equatorial Guinea” or “Colombia” or “Colombia” or “Macedonia Republic” or “Macedonia”) and “Republic”) or “Macedonia Republic” or “Macedonia” or “Thailand” or “Thailand” or “Costa Rica” or “Malaysia” or “Malaysia” or “Turkey” or “Turkey” or “Cuba” or “Cuba” or “Indian Ocean Islands” or “Indian”) and “Ocean” and “Islands”) or “Indian Ocean Islands” or “Maldives” or “Turkmenistan” or “Turkmenistan” or “Saint Lucia” or “Bulgaria” or “Bulgaria” or “Lebanon” or “Lebanon” or “St. Vincent” or “Saint Vincent” or “Saint Vincent And The Grenadines” or “Saint”) and “Vincent” and “Grenadines”) or “Saint Vincent And The Grenadines” or “Grenadines” or “China” or “China” or “Libya” or “Libya” or “Suriname” or “Suriname” or “Bosnia And Herzegovina” or “Bosnia”) and “Herzegovina”) or “Bosnia And Herzegovina” or “Bosnia” or “Bosnia And Herzegovina” or “Bosnia”) and “Herzegovina”) or “Bosnia And Herzegovina” or “Herzegovina” or “Jamaica” or “Jamaica” or “Serbia” or “Serbia” or “Botswana” or “Botswana” or “Jordan” or “Jordan” or “South Africa” or “Brazil” or “Brazil” or “Kazakhstan” or “Kazakhstan” or “St. Lucia” or “Paraguay” or “Paraguay” or “Azerbaijan” or “Azerbaijan” or “Guyana” or “Guyana”) and “Peru”) or “Peru” or “Republic Of Belarus” or “Republic”) and “Belarus”) or “Republic Of Belarus” or “Belarus” or “Iran” or “Iran” or “Romania” or “Romania” or “Belize” or “Belize” or “Iraq” or “Iraq” or “Russian Federation” or “Russia” or “India” or “India” or “Philippines” or “Philippines” or “Zambia” or “Zambia” or “Albania” or “Albania” or “Fiji” or “Fiji” or “Namibia” or “Namibia” or “Algeria” or “Algeria” or “Gabon” or “Gabon” or “Palau” or “Palau” or “Samoa” or “Samoa” or “Angola” or “Angola” or “Grenada” or “Grenada” or “Guatemala” or “Guatemala” or “Pakistan” or “Pakistan” or “West Bank” or Gaza or “Palestine” or “Honduras” or “Honduras” or “Papua New Guinea” or “New Guinea” or “Yemen” or “Yemen” or “Uzbekistan” or “Uzbekistan” or “El Salvador” or “Nicaragua” or “Nicaragua” or “Vanuatu” or “Vanuatu” or “Ghana” or “Ghana” or “Nigeria” or “Nigeria” or “Vietnam” or “Vietnam” or “Cote d’Ivoire” or “Ivory Coast” or “Mongolia” or “Mongolia” or “Tunisia” or “Tunisia” or “Djibouti” or “Djibouti” or “Morocco” or “Morocco” or “Ukraine” or “Ukraine” or “Egypt” or “Egypt” or “Myanmar” or “Myanmar” or “Mauritania” or “Mauritania” or “Tajikistan” or “Tajikistan” or “Cameroon” or “Cameroon” or “Micronesia” or “Micronesia” or “Timor-Leste” or “Timor” or “Congo” or “Congo” or “Moldova” or “Moldova” or “Tonga” or “Tonga” or Lao or “Laos” or “Laos” or “Swaziland” or “Swaziland” or “Cabo Verde” or “Costa Verde” or “Lesotho” or “Lesotho” or “Syria” or “Syria” or “Syrian Arab Republic” or “Cambodia” or “Cambodia” or “Armenia” or “Armenia” or “Micronesia” or “Micronesia” or “Kiribati” or “Solomon Islands” or “Bangladesh” or “Bangladesh” or “Kosovo” or “Kosovo” or “Sri Lanka” or “Sri”) and “Lanka”) or “Sri Lanka” or “Bhutan” or “Bhutan” or Kyrgyz or “Sudan” or “Sudan” or “Bolivia” or “Bolivia” or “Africa” or “Georgia Republic” or “Panama” or “low income country” or “low income countries” or “low income economy” or “low income economies” or “middle income country” or “developing countries” or “developing nations” or “developing country” or “developing nation” or “middle income countries” or “middle income nation” or “middle income nations” or “middle income economies” or “low income nations” or “third world” or developmental* delay* or adhd or attention deficit or injury or injuries or tumor or tumors or cancer* or leukemia* or disability or disabilities or arthritis or developmental disorder* or arthritis or “scoliosis” or “Kawasaki” or asthma* or cerebral palsy or prematur* or infant* or newborn* or “sickle cell” or arthritis or schizophren* or surgery or osteoarthritis or elderly or food allerg* or (mexico not new mexico).mp.

7. 5 NOT 6

8. Limit 7 (english language and yr=”1990 -Current”)

Despite the finding of insufficient evidence, the following are considerations for implementation drawn from studies included in the evidence review, the broader literature, and expert opinion.

The Centers for Disease Control and Prevention offers guidance documents to assist with program implementation.

• Increasing Access to Drinking Water in Schools Tool Kit provides step by step guidance
• Comprehensive School Physical Activity Program Framework for planning and organizing activities for school physical education and physical activity