Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity | Lifestyle Behaviors | JAMA Pediatrics | JAMA Network
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Ludwig  DS, Peterson  KE, Gortmaker  SL.  Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis.  Lancet. 2001;357(9255):505-508.PubMedGoogle ScholarCrossref
Ebbeling  CB, Feldman  HA, Chomitz  VR,  et al.  A randomized trial of sugar-sweetened beverages and adolescent body weight.  N Engl J Med. 2012;367(15):1407-1416.PubMedGoogle ScholarCrossref
de Ruyter  JC, Olthof  MR, Seidell  JC, Katan  MB.  A trial of sugar-free or sugar-sweetened beverages and body weight in children.  N Engl J Med. 2012;367(15):1397-1406.PubMedGoogle ScholarCrossref
Pan  A, Malik  VS, Hao  T, Willett  WC, Mozaffarian  D, Hu  FB.  Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies.  Int J Obes (Lond). 2013;37(10):1378-1385.PubMedGoogle ScholarCrossref
Ogden  CL, Carroll  MD, Kit  BK, Flegal  KM.  Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010.  JAMA. 2012;307(5):483-490.PubMedGoogle ScholarCrossref
Ogden  CL, Carroll  MD, Kit  BK, Flegal  KM.  Prevalence of childhood and adult obesity in the United States, 2011-2012.  JAMA. 2014;311(8):806-814.PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention.  Obesity in K-8 students: New York City, 2006-07 to 2010-11 school years.  MMWR Morb Mortal Wkly Rep. 2011;60(49):1673-1678.PubMedGoogle Scholar
Childhood obesity facts. http://www.cdc.gov/healthyyouth/obesity/facts.htm. Accessed September 9, 2014.
Dietz  WH.  Health consequences of obesity in youth: childhood predictors of adult disease.  Pediatrics. 1998;101(3, pt 2)(suppl 2):518-525.PubMedGoogle Scholar
Must  A, Strauss  RS.  Risks and consequences of childhood and adolescent obesity.  Int J Obes Relat Metab Disord. 1999;23(suppl 2):S2-S11.PubMedGoogle ScholarCrossref
Perlman  SE, Nonas  C, Lindstrom  LL, Choe-Castillo  J, McKie  H, Alberti  PM.  A menu for health: changes to New York City school food, 2001 to 2011.  J Sch Health. 2012;82(10):484-491.PubMedGoogle ScholarCrossref
Regulation of the chancellor: competitive foods, A-812. http://schools.nyc.gov/NR/rdonlyres/381F4607-7841-4D28-B7D5-0F30DDB77DFA/78296/A812FINAL.pdf. Accessed November 25, 2014.
Reversing the epidemic: the New York City obesity task force plan to prevent and control obesity. http://www.nyc.gov/html/om/pdf/2012/otf_report.pdf. Accessed September 9, 2014.
New York City obesity task force: interim progress report. http://www.nyc.gov/html/nycfood/downloads/pdf/obesity-task-force-scorecard-12-31-13-final.pdf. Accessed September 9, 2014.
Giles  CM, Kenney  EL, Gortmaker  SL,  et al.  Increasing water availability during afterschool snack: evidence, strategies, and partnerships from a group randomized trial.  Am J Prev Med. 2012;43(3)(suppl 2):S136-S142.PubMedGoogle ScholarCrossref
Muckelbauer  R, Libuda  L, Clausen  K, Toschke  AM, Reinehr  T, Kersting  M.  Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial.  Pediatrics. 2009;123(4):e661-e667.PubMedGoogle ScholarCrossref
Elbel  B, Mijanovich  T, Abrams  C,  et al.  A water availability intervention in New York City public schools: influence on youths’ water and milk behaviors.  Am J Public Health. 2015;105(2):365-372.PubMedGoogle ScholarCrossref
Rundle  A, Richards  C, Bader  MD,  et al.  Individual- and school-level sociodemographic predictors of obesity among New York City public school children.  Am J Epidemiol. 2012;176(11):986-994.PubMedGoogle ScholarCrossref
Berkson  SS, Espinola  J, Corso  KA, Cabral  H, McGowan  R, Chomitz  VR.  Reliability of height and weight measurements collected by physical education teachers for a school-based body mass index surveillance and screening system.  J Sch Health. 2013;83(1):21-27.PubMedGoogle ScholarCrossref
Morrow  JR  Jr, Martin  SB, Jackson  AW.  Reliability and validity of the FITNESSGRAM: quality of teacher-collected health-related fitness surveillance data.  Res Q Exerc Sport. 2010;81(suppl 3):S24-S30. PubMedGoogle ScholarCrossref
A SAS program for the 2000 CDC growth charts (ages 0 to <20 years). http://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm. Accessed May 13, 2014.
Centers for Disease Control and Prevention.  Effects of switching from whole to low-fat/fat-free milk in public schools: New York city, 2004-2009.  MMWR Morb Mortal Wkly Rep. 2010;59(3):70-73.PubMedGoogle Scholar
Angrist  JD, Pischke  J.  Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton, NJ: Princeton University Press; 2008.
Is chocolate milk good for you? http://www.healthyeating.org/Milk-Dairy/Dairy-Facts/Chocolate-Milk.aspx. Accessed November 26, 2014.
Centers for Disease Control and Prevention. Beverage consumption among high school students: United States, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6023a2.htm. Updated 2010. Accessed July 31, 2014.
Original Investigation
March 2016

Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity

Author Affiliations
  • 1Maxwell School, Syracuse University, Syracuse, New York
  • 2New York University Institute for Education and Social Policy, New York
  • 3New York University School of Medicine, New York
  • 4New York University Robert F. Wagner Graduate School of Public Service, New York
JAMA Pediatr. 2016;170(3):220-226. doi:10.1001/jamapediatrics.2015.3778

Importance  Decreasing the amount of caloric beverages consumed and simultaneously increasing water consumption is important to promoting child health and decreasing the prevalence of childhood obesity.

Objective  To estimate the impact of water jets (electrically cooled, large clear jugs with a push lever for fast dispensing) on standardized body mass index, overweight, and obesity in elementary school and middle school students. Milk purchases were explored as a potential mechanism for weight outcomes.

Design, Setting, and Participants  This quasi-experimental study used a school-level database of cafeteria equipment deliveries between the 2008-2009 and 2012-2013 and included a sample of 1227 New York, New York, public elementary schools and middle schools and the 1 065 562 students within those schools.

Intervention  Installation of water jets in schools.

Main Outcomes and Measures  Individual body mass index (BMI) was calculated for all students in the sample using annual student-level height and weight measurements collected as part of New York’s FITNESSGRAM initiative. Age- and sex-specific growth charts produced by the Centers for Disease Control and Prevention were used to categorize students as overweight and obese. The hypothesis that water jets would be associated with decreased standardized BMI, overweight, and obesity was tested using a difference-in-difference strategy, comparing outcomes for treated and nontreated students before and after the introduction of a water jet.

Results  This study included 1 065 562 students within New York City public elementary schools and middle schools. There was a significant effect of water jets on standardized BMI, such that the adoption of water jets was associated with a 0.025 (95% CI, −0.038 to −0.011) reduction of standardized BMI for boys and a 0.022 (95% CI, −0.035 to −0.008) reduction of standardized BMI for girls (P < .01). There was also a significant effect on being overweight. Water jets were associated with a 0.9 percentage point reduction (95% CI, 0.015-0.003) in the likelihood of being overweight for boys and a 0.6 percentage reduction (95% CI, 0.011-0.000) in the likelihood of being overweight for girls (P < .05). We also found a 12.3 decrease (95% CI, −19.371 to −5.204) in the number of all types of milk half-pints purchased per student per year (P < .01).

Conclusions and Relevance  Results from this study show an association between a relatively low-cost water availability intervention and decreased student weight. Milk purchases were explored as a potential mechanism. Additional research is needed to examine potential mechanisms for decreased student weight, including reduced milk taking, as well as assessing impacts on longer-term outcomes.