Replace Percentage of SSBs with Water in Schools

Across all youth ages 2-19, sugar-sweetened beverages (SSBs) contributed on average of 224 kcal/day in 1999 to 2004. The intervention assumes that the selected group is replacing the average amount of SSBs consumed for that group during the school day with water.

Wang et al. document an increase in caloric contributions from sugar-sweetened beverages and 100% fruit juice among U.S. youth during 1988-2004. Based upon National Health and Nutrition Examination Survey (NHANES) data for these years, the study found that children and adolescents derive 10-15% of their total calories from SSBs and 100% fruit juices. On a typical weekday, 55-70% of SSB calories were consumed in the home, and 7-15% were in school. The calculation assumes that vending machine purchases occur in school.

The following inputs are used in the estimates provided: for preschool students (age 2-5), an average of 124 kcal/day of SSBS are consumed, with 5.48% of this amount from school; for elementary school students (age 6-11), an average of 184 kcal/day of SSBs are consumed, with 6.47% of this amount from school; and for middle and high school students, 301 kcal/day of SSBS are consumed, with 10.3% of this amount from school.

Ogden reports slightly different values for males and females within each age group, drawing from NHANES, 2005-2008. The following are values from the Ogden analysis on number of daily kcals consumed on average for the specified group:
Sex Age Group Avg. kcal
Boys     2-5 71
Girls     2-5 70
Boys     6-11 141
Girls     6-11 112
Boys     12-19 273
Girls     12-19 171

Muckelbauer et al. has also implemented a similar study that combined environmental and educational components that promoted water consumption in 32 elementary schools in socially-deprived, urban neightborhoods of two German cities. Water foundations were installed and students received a water bottle to use. Teachers gave four 45-minute classroom lessons over the course of 1 year to promote water consumption.

On average, a school year is 180 days. The intervention assumes that the change is over the course of a school year (so if 10 minutes are added per day, it is added for 180 days). The total caloric impact is then averaged over 365 days to account for no change in activity on holidays, weekends, and summer vacation.

* The Average Caloric Impact (ACI) for this intervention is modeled based on published data on impacted popultion and amounts consumed from Wang et al. (2008).

Studies Used in Estimates

Wang YC, Blelch SN, Gortmaker SL. Increasing Caloric Contribution From Sugar-Sweetened Beverages and 100% Fruit Juices Among U.S. Children and Adolescents, 1998-2004. Pediatrics 2008; 121(6):e1604-e1614.

Other References

Ogden CL, Kit BK, Carroll MD, Park S. Consumption of Sugar Drinks in the United States, 2005-2008. NCHS Data Brief 2011 Aug; 71.

Muckelbauer R, Libuda L, Clausen K, Reinehr T, Kersting M. A Simple Dietary Intervention in the School Setting Decreased Incidence of Overweight in Children. Obesity Facts 2009; 2:282-285.

Poti JM, Popkin BM. Trends in Energy Intake Among US Children by Eating Location and Food Source, 1977-2006. Journal of the American Dietetic Association 2011 Aug; 111(8):1156-1164.