Photo by Urszula Ambroży

Author: Lisa Drake

When I was a young child growing up, all of the adults in my life told me to drink water. I’m sure we have all been told about the importance of drinking water. There are numerous theories discussed on the internet and social media about the importance of drinking a certain number of liters of water every day to stay in shape, and it’s usually mentioned in the context of a sneaky advertisement for a new, advanced technology water bottle that will solve all of our hydration problems. Though, is this really true and how many people know the science and health benefits behind water in the human diet? Of course, most people know that we need to drink water to simply quench our thirst. Yet, in reality, about 60% of the human body is composed of water and all of the essential organs inside the human body are majorly composed of water; for example, the brain and heart are made of 73% water, while the lungs even more so are made of 83% water [1]. Since water is so much a part of who we are, it is needed to perform essential functions in the human body. For example, regulating body temperature through sweating and respiration, lubrication of joints, protection of the spinal cord, brain and other sensitive tissues, as well as expelling waste, etc. [2].

Everyone can enjoy health benefits from consuming an adequate amount of water on a daily basis. However, children in particular need to be mindful about consuming enough water because the bodies of babies and children are made of a higher percentage of water than adults. For example, babies are made of approximately 78% water [1]. Water is also an ideal beverage to promote the maintenance of a healthy body weight and may be a protective factor in the prevention of overweight/obesity because water is a calorie-free drink [2]. An increase in water consumption can be used to replace overconsumption of caloric, sugar-sweetened beverages (SSBs) which studies have shown to be directly linked to obesity through a dose-response relationship [3] [4]. It has also been shown to suppress hunger – not only improve overall hydration [5].

It is best to target interventions to encourage the consumption of water and discourage the consumption of other beverages that are high in added sugars and excess calories among children in younger age groups, such as primary school children or even younger. That is the age at which people begin to develop health-related behaviors. Once these behaviors are developed early in life, it is easier for children to carry them throughout adolescence and adulthood than it is to change to healthier habits later in life [6]. The most effective school-based programmes to increase water consumption, decrease the incidence of childhood obesity, and decrease obesity-related behaviors in children have been shown to last at least for one year or more [7]. The school environment has been thought to be the best target environment to instil healthy habits in the youth population because children typically spend the majority of their time at school [8].

The EU Action Plan on Childhood Obesity 2014-2020 highlights some recommendations for interventions to increase water consumption and decrease sugar-sweetened beverage intake among schoolchildren in Europe [9]. Recommendations for interventions are to include an educational health promotion strategy and changes to the school environment to encourage water consumption. The educational component can include lessons to teach children about the importance of drinking water daily using both traditional classroom learning strategies alongside more engaging methods like through quizzes, music and games. Changes in the built environment can include installing water fountains, adding water filters, and providing free refillable water bottles to pupils. Storcksdieck gennant Bonsmann and his team (2016) also recommend combining the above strategies with policy changes in schools to limit access to sugar-sweetened beverages to discourage the consumption of these caloric soft drinks and fruit juices at school [9]. Some examples of these strategies are to not allow children to leave the school campus during school hours, reduce the sizes of SSBs sold in schools, and restrict access to vending machines or school shops during limited hours, like only at lunch time.

There is also the possibility of providing information at the point of sale of SSBs to raise awareness of the sugar and/or calorie content of these beverages and suggest healthier options as well as using health promotional messaging, like in the form of signs, posters, banners, etc. within schools that contain messages to encourage pupils to drink water. This report also suggests the importance of a parental/family component to educate families about the importance of ensuring that their children consume more water and less SSBs in both the school and home environment, since all children will eventually leave school to go home to their families or caregivers. Suggested strategies in this regard that have been shown to be effective are holding informational sessions for parents after school or in the evenings to give parents the necessary information on these issues, provide families with informational material either through websites, printed brochures/leaflets, and/or follow-up phone calls, and take-home reward incentives for parents and children to drink water including gifts, stickers, gadgets, etc. [9]. Not every intervention can possibly include all of these components, but when creating a new intervention, it is useful to consult these practices and include some of them into the program to have the best chance of long-term effectiveness to increase water consumption among children, while decreasing the consumption of other beverages.

An example of a school-based intervention to encourage water consumption among school aged children [9] piloted an intervention in which drinking fountains were installed in schools, a free water bottle was given to every child and teachers included in their lessons the reasons and importance for drinking water at school in the experimental group. This strategy was found to be effective in both increasing self-reported water consumption by 1.2 glasses of water per day while decreasing soft drink and juice consumption to an average of 0.2 glasses per day. It was also found to lower the incidence of overweight by 3.7% (compared to those who did not receive this intervention had an overweight incidence rate of 6%).

There are many ideas and interventions that target different age groups to encourage water consumption, particularly in the school environment, among children and to instil healthy lifestyle habits at the youngest ages possible. The habits that children learn and practice early and life are most likely to stay with them into adolescence and adulthood. In the adulthood it is difficult for most people to change their behaviors. Therefore, it is important to encourage positive health behaviors as early in life as possible [8]. Even though these strategies have focused on school children, everyone can reap the benefits of increasing water consumption and decreasing the consumption of beverages high in sugar and calories. These benefits include not only hydration (obviously), but also weight maintenance, suppression of hunger, and improvement of the overall health. There may not be scientific evidence that one needs to buy the newest water bottle or filter technology being advertised. However the evidence is strong that simple choices – such as carrying a bottle of water during the day and choosing to drink water instead of soda at a meal – can lead anyone on the path of better health, wellbeing, and longevity for the future.

Author was a student of the EuroPubHealth Programme

at the Institute of Public Health, Jagiellonian University Medical College.

The text was supervised by Beata Piórecka, PhD

Public Health Blog | Blog Zdrowia Publicznego, ed. M. Zabdyr-Jamróz, Institute of Public Health JU MC, Kraków: 12 February 2021

References:

1. The Water in You: Water and the Human Body n.d. https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects (accessed December 3, 2020).
2. Water and Healthier Drinks | Healthy Weight, Nutrition, and Physical Activity | CDC n.d. https://www.cdc.gov/healthyweight/healthy_eating/water-and-healthier-drinks.html (accessed December 3, 2020).
3. Get the Facts: Drinking Water and Intake | Nutrition | CDC n.d. https://www.cdc.gov/nutrition/data-statistics/plain-water-the-healthier-choice.html (accessed December 3, 2020).
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6. Muckelbauer R, Libuda L, Clausen K, Reinehr T, Kersting M. A simple dietary intervention in the school setting decreased incidence of overweight in children. Obes Facts 2009;2:282–5. https://doi.org/10.1159/000229783.
7. Weihrauch-Blüher S, Kromeyer-Hauschild K, Graf C, Widhalm K, Korsten-Reck U, Jödicke B, et al. Current Guidelines for Obesity Prevention in Childhood and Adolescence. Obes Facts 2018;11:263–76. https://doi.org/10.1159/000486512.
8. Center for Disease Control. (2014) Increasing Access to Drinking Water and Other
9. Healthier Beverages in Early Care and Education Settings, 2014.
10. Storcksdieck gennant Bonsmann, S., Mak, T.N., Caldeira, S. and Wollgast, J. (2016). How to Promote Water Intake in Schools: a Toolkit. [online] JRC Science for Policy Report, Italy: European Commission, pp.1–22. Available at: https://publications.jrc.ec.europa.eu/repository/bitstream/JRC100991/jrc_policytoolkit_w_%28online%29.pdf.