Welcome to The Community Guide! Let us know what you think of the website by completing this quick survey.

Obesity: Increasing Water Access in Schools


What the CPSTF Found

About The Systematic Review

In 2013, the Agency for Healthcare Research and Quality (AHRQ) conducted a meta-analysis on the effectiveness of childhood obesity prevention programs implemented in 6 intervention settings. The CPSTF finding is based on a subset of studies from the review that focused on dietary-only approaches in schools (Wang et al., 2013; 15 studies, search period through August 2012) combined with more recent evidence (36 additional studies, search period August 2012 to January 2017).

This 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.


Healthy eating during childhood is important (CDC, 1998; Dietary Guidelines Advisory Committee, 2010). Schools can play an important role in preventing obesity by providing nutritious and appealing foods and beverages (CDC, 2016a; CDC, 2011).

Summary of Results

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 1.24 MB].

The systematic review included 2 studies.

Weight-Related Outcomes

  • Overweight/Obesity Prevalence – significant decrease (1 study)
  • The risk of overweight was significantly reduced in the intervention group compared to the control group (1 study)

Diet-Related Outcomes

  • Sugar-sweetened beverage intake – no intervention effect (1 study)
  • Water intake – significant increase of 1.1 glasses per day; p<0.001 (1 study)
  • Fruit juice intake – decrease of 0.1 glasses per day (1 study)

Summary of Economic Evidence

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.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • Which intervention activities, such as allowing water bottles in class, adding water fountains or dispensers, or combinations of these activities are most effective? Which activities are critical to success?
  • What are the cumulative effects of adding intervention components? Is a single component equally effective?
  • In order to increase comparability what are the “best measures” for dietary intake outcomes?
  • Do children act as agents of change by discussing changes in the school environment with parents? Do parents incorporate healthier dietary habits at home?
  • How often do schools implement interventions with fidelity? What amount of training is needed for faculty?
  • Does effectiveness vary by age group?
  • Are national, state, or local policies most effective?
  • Approximately half of the studies reported on weight outcomes; future studies should report weight-related outcomes to increase understanding of intervention effectiveness.
  • For studies reporting on milk products and alternatives to dairy, what is the fat content of these foods and beverages?
  • Do interventions lead to other health benefits such as improvements in cholesterol or blood pressure?

Study Characteristics

  • Study designs included group randomized trial (1 study) and repeat cross-sectional with concurrent comparison group (1 study).
  • Studies were conducted in the United States (1 study) and Germany (1 study).
  • Both studies evaluated interventions conducted in schools alone.
  • One study was implemented in elementary and middle schools and 1 study was implemented in an elementary school only.
  • Both studies were set in urban areas.
  • One study was implemented in a lower socioeconomic population.