Elementary school water program prevented increases in overweight prevalence
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Key takeaways:
- An initiative to promote water drinking at elementary schools in San Francisco led to a reduction in overweight prevalence among students.
- The intervention did not have an effect on obesity prevalence.
A program to promote water drinking in elementary schools prevented increases in the prevalence of students with overweight, a study published in Pediatrics found.
According to one of the authors, the idea for the study came out of an aim to develop an obesity prevention program for teenagers in middle schools.
“I was working with a team that was using a research approach called community-based participatory research, where you work with communities to actually develop research, ideas and interventions with the community,” Anisha I. Patel, MD, MSPH, MSHS, director of community-engaged research at Stanford University’s Maternal and Child Health Research Institute, told Healio. “We came to Los Angeles and were first just going to talk to students and parents and observe the schools to see what topics were most important for the program.”
During one observation day at a middle school in October, there was a “very hot L.A. sun,” Patel said.
“We were standing at the school observing the students and what they were eating in the cafeteria,” Patel said. “And some teens came up and said, ‘What we really think we need is water with our lunch.’ What got this all started was these teenagers coming up and saying, ‘We really want to have cold water available with our lunch.’”
Patel and colleagues found that the water available to students came from ceramic, porcelain drinking fountains that were warm and not refrigerated.
“The students weren't able really to go out and drink from them, or they didn't even want to because the water was lukewarm,” Patel said. “They also had concerns about water quality, as a lot of these schools were in low-income areas. So, we developed a small program, which then led to this study.”
Patel and colleagues cluster-randomized 1,249 students from 18 low-income, ethnically diverse elementary schools in California’s San Francisco Bay Area into intervention and control groups as part of a program they called Water First. The school-based water promotion and access intervention included classroom lessons, water bottle filling stations, testing water for lead and schoolwide water promotion over 1 school year.
“One [component of the program] was that we wanted to make sure that drinking water was actually accessible to students in the schools, so we installed a water dispenser with cups in the cafeteria, and we actually worked with the schools to figure out whether they wanted compostable recyclable cups,” Patel said.
“We also installed two water bottle filling stations, and those were put in high traffic areas, typically somewhere where the students were physically active where they were engaging in recess or [physical education] classes. And then we worked with the schools to really identify the other location based on where they had plumbing or where they felt like a lot of staff and students would be using the station.”
Although the authors noted no significant difference in prevalence up to the 7-month point, when examining the results from baseline to 15 months, they found that increases in overweight prevalence were significantly greater in control schools (3.7%) compared with intervention schools (0.5%). The program did not affect obesity prevalence.
“The fact that we were able to see prevention impacts on overweight was promising for us,” Patel said. “We also did see promising results for water intake and also sugar-sweetened beverages.”
Patel said she would be interested in seeing the study format adapted to new settings.
“We actually have similar projects happening in early care and education or child care centers [that are] pretty similar to this,” Patel said. “While I'm not an adult physician, I think any intervention, to be really successful, needs to focus on the caregivers in the home. ... I think that that's a critical component for any school-based intervention.”
References:
- Partnerships for Research in Child Health. Water First. https://researchinchildhealth.org/water-first. Accessed August 7, 2023.
- Patel AI, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060021.
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