Promoting healthy beverages through child care holds promise in fostering healthier beverage choices and weight

Effects of a children's beverage intervention

The Nutrition Society Paper of the Month for July is from Public Health Nutrition and is entitled 'Effects of a multipronged beverage intervention on young children’s beverage intake and weight: a cluster-randomized pilot study’ by Authors Anna H Grummon, Michael D Cabana, Amelie A Hecht, Abbey Alkon, Charles E McCulloch, Claire D Brindis and Anisha I Patel.

Despite intense focus on childhood obesity prevention over the last two decades, progress has been slow. Unfortunately, even the youngest are affected: more than one in four preschool-age children (2-5 years) have excess weight. Eleven million American pre-schoolers attend child care, meaning that effective interventions to curb obesity in child care settings could have substantial impact in helping young children achieve and maintain a healthier weight.

Can a Child Care Intervention Focused Exclusively on Beverages Help Children Achieve a Healthier Weight?

Our team tested a novel intervention for promoting healthier weight in young children. Rather than focusing on changing a number of different weight-related behaviours at once, our intervention focused on just one behaviour: helping children drink more water and low-fat milk and fewer sweet drinks like sodas and juice. Our hope was that focusing on one key behaviour would make it easier for child care providers and families to make healthy changes.

Our pilot intervention was delivered via four child care centres serving low-income children in California, U.S.A. Half of the centres were randomized to receive the intervention right away, and the other half received intervention materials after the study was completed. 

The intervention lasted twelve weeks and addressed three key factors related to beverages: environment, policies, and education. To address the beverage environment, we helped child care centres make drinking healthier beverages the easy choice. We provided small, child-friendly pitchers and cups so centres could offer water at meals and snacks. We also gave children their own personalized water bottles so that they could drink water easily throughout the day. To support policy changes, we provided technical assistance to help centres modify their policies and handbooks to support healthier beverage options for children and staff. Families were also asked to commit to setting healthy beverage goals at home.  The third key part of the intervention was education. We provided fun, age-appropriate educational materials and activities for both children and their parents, including children’s book about water and a catchy children’s song about drinking water.

To evaluate the intervention, we compared how beverage habits and weight changed over time among children in centres that received the intervention vs. those in the control centres that did not receive the intervention. We found that, compared to children in the control group, children receiving the intervention reduced their consumption of unhealthy beverages over time – they drank less juice, sugary drinks, and sweetened or high-fat milk. They also drank more water and unsweetened low-fat/fat-free milk, though this change was not statistically significant. While we did not observe significant differences in overweight/obesity between the groups, trends suggested that if the intervention was extended over a longer period, it could help children maintain healthier weights.

What does this mean?

Our study suggests that a comprehensive child care intervention that focuses on healthy beverage habits could hold promise as a strategy for helping young children maintain a healthier weight. Future research should test this type of intervention with larger numbers of children and over longer periods of time.