Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e661-e667 (doi:10.1542/peds.2008-2186)
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ARTICLE

Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial

Rebecca Muckelbauer, MSca, Lars Libuda, MSca, Kerstin Clausen, PhDa, André Michael Toschke, MD, MSc, MPHb, Thomas Reinehr, MDc and Mathilde Kersting, PhDa

a Research Institute of Child Nutrition Dortmund, Department of Dietary Behavior, Dortmund, Germany
b Division of Health and Social Care Research, Department of Public Health Sciences, King's College London, London, England
c Department of Pediatric Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Witten-Herdecke, Germany

OBJECTIVE. The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school.

METHODS. The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007).

RESULTS. Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean ± SD: 8.3 ± 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent.

CONCLUSION. Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.

Key Words: overweight • prevention • children • diet • environment

Abbreviations: CG—control group • CI—confidence interval • IG—intervention group • SDS—SD score

Accepted Dec 16, 2008.


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