Water is fundamental for life and health. The human right to water is indispensable for leading a healthy life in human dignity. It is a prerequisite for the realization of all other human rights.

United Nations Declaration, 2002

Vision of the project

The ReachforWater

ReachforWater is the product of collaboration among a multidisciplinary team of international experts from universities in Québec, Ontario and the US.

The ReachforWater program’s main goal is to normalize the consumption of non-bottled drinking water as the only drink necessary for hydration. The program also aims to denormalize the consumption of sugar containing drinks and bottled water. These health and environment promoting strategies promote the appreciation of the value of, and optimal utilization of non-bottled drinking water

The clinical objectives of this research project are to evaluate whether the ReachforWater Intervention can increase water consumption and decrease sugar-containing beverages intake, and thus curb childhood overweight among primary school children in Québec.

ReachforWater addresses contemporary issues such as overweigtht, liquid sugars, water quality and environmental awareness (including disposable plastic bottles). ReachforWater draws on social justice approaches wherein all have access to solutions and to pleasure. Given that school is a place of learning and for the transmission of values, the consideration of lifestyle habits must be included at school on a daily basis.

Interventions seeking to address the problem of childhood obesity, healthy hydration habits, and of the human environmental footprint are of capital importance. ReachforWater proposes solutions to these problems and will enable informed decision making regarding the upscaling of the intervention on a provincial scale.

Justification

Sugar containing beverages are aggressively marketed to children (1). They represent the principal source of free sugar in their diet, and are a modifiable risk factor for overweight (2). The transition away from the consumption of water and towards that of sugar containing beverages is a factor contributing to excess weight gain (3,4). Contrary to sugar containing beverages, non-bottled water is poorly marketed, constitutes the optimale beverage for quenching thirst and hydration, and when substituted for sugar containing beverages, prevents overweight (5,6). The ReachforWater Intervention was designed to address the weaknesses of past interventions and for the evolution towards the normalization of the consumption of non-bottled drinking water and discouraging that of sugar containing beverages.

In 2016, the World Health Organization (WHO) Commission on Ending Childhood Obesity launched a call for action on obesogenic environments (obesity-enhancing) and standards for the consumption of unhealthy foods and sugar-sweetened beverages among children (7,8). The WHO recommends improved access to water in schools as a substitute for sugar containing beverages. Three school-based interventions outside of Canada have tested the promotion of the consumption of drinking water (9-11). They have demonstrated the feasibility of such interventions as well as a certain level of efficacy, on increased water intake and notably on the reduction of excess weight gain.

In Québec schools the evaluation of the access to drinking water and of its quality is not well known. In fact, Ontario is the only province in Canada with legislation regarding drinking water in schools. However, there is no concensus regarding the monitoring of water (12, 13). Our research project will also address the significant issue of missing information regarding the current state of water quality available in Québec schools.

Did you know that an average of 3 litres of water and 0.15 litres of oil would be required to bottle 1 litre of water? Although recyclable, only 33% of water bottles are recycled? (14)

In effect, having an impact during childhood requires actions on several levels : school, home, education, and on the physical environment, while applying marketing strategies used with success by the beverage bottling industry. ReachforWater seeks to contribute in a substantial way to the creation of environments supportive of health by rendering quality water accessible and pleasurable and to environmental protectionby educating on the effects of using non-reusable bottles and on water as a collective ressource and human right.

The justification for this project stems from established knowledge including:

  • Eating (and drinking) habits develop from infancy and persist
  •  Sugar-containing beverages are aggressively marketed and are the main source of free sugar in the diet of children
  • Excess of free sugar is associated with multiple health problems such as overweight/obesity, diabetes and tooth decay.
  • Water is the ultimate beverage for hydration
  • Beverages sold in non-reusable plastic bottles is an unsustainable practice
  • The state of drinking water quality in Québec’s schools remains unclear
  • Schools are ideal environments for the promotion of healthy lifestyles and the creation of healthy environments

References


1. Borges MC, Louzada ML, de Sa TH, et al. Artificially Sweetened Beverages and the Response to the Global Obesity Crisis. PLoS Med. 2017; 14(1):e1002195.


2. Institut National de la Santé Publique du Québec. La consommation de sucre et la santé Comité scientifique sur la prévention de l’obésité — Fiche thématique. 2 mars 2017 Available at: (Date of last access, March 2017).


3. Popkin BM. Contemporary nutritional transition: determinants of diet and its impact on body composition. Proc Nutr Soc. 2011; 70(1):82-91.


4. Wolf A, Bray GA, Popkin BM. A short history of beverages and how our body treats them. Obes Rev. 2008; 9(2):151-164.


5. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010; 68(8):439-458.


6. 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.


7. World Health Organization. (2016). Commission on Ending Childhood Obesity. Report of the Commission on Ending Childhood Obesity. Available at: who.int/end-childhood-obesity/final-report/en/ (Date of last access, February 2016)


8. Nishtar, S., Gluckman, P., Armstrong, T. (2016). Ending childhood obesity: a time for action. Lancet; 387(10021):825-7.


9. Muckelbauer, R., Libuda, L., Clausen, K., et al. (2009). Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics;123(4):e661-67.


10. Elbel, B., Mijanovich, T., Abrams, C., et al. (2015). A water availability intervention in New York City public schools: influence on youths’ water and milk behaviors. Am J Public Health; 105(2):365-72.


11. Savage, J.S., Fisher, J.O., Birch, L.L. (2007). Parental influence on eating behavior: conception to adolescence. J Law Med Ethics; 35(1):22-34.


12. Barn, P., Nicol, A-M., Struck, S., Dosanjh, S., Li, R., Kosatsky, T. (2013). Investigating elevated copper and lead levels in school drinking water. Environmental Health Review; 56:96-102.


13. Barn, P., Kosatsky, T. (2011). Lead in school drinking water: Canada can and should address this important ongoing exposure source. Can J Public Health; 102(2):118-21.


14. Eau embouteillée. Approvisionnement responsable. Développement durable. Université Laval. Available at: http://www.sf.ulaval.ca/approvisionnement/pdf/Fiche-AR_bouteilleeau.pdf (Date of last access, March 2017)