Skip to main content Accessibility help

Effects of a multipronged beverage intervention on young children’s beverage intake and weight: a cluster-randomized pilot study

  • Anna H Grummon (a1) (a2), Michael D Cabana (a3) (a4) (a5), Amelie A Hecht (a6), Abbey Alkon (a7), Charles E McCulloch (a5), Claire D Brindis (a3) (a4) (a8) and Anisha I Patel (a9)...



To evaluate whether a multipronged pilot intervention promoting healthier beverage consumption improved at-home beverage consumption and weight status among young children.


In this exploratory pilot study, we randomly assigned four childcare centres to a control (delayed-intervention) condition or a 12-week intervention that promoted consumption of healthier beverages (water, unsweetened low- or non-fat milk) and discouraged consumption of less-healthy beverages (juice, sugar-sweetened beverages, high-fat or sweetened milk). The multipronged intervention was delivered via childcare centres; simultaneously targeted children, parents and childcare staff; and included environmental changes, policies and education. Outcomes were measured at baseline and immediately post-intervention and included children’s (n 154) at-home beverage consumption (assessed via parental report) and overweight/obese status (assessed via objectively measured height and weight). We estimated intervention impact using difference-in-differences models controlling for children’s demographics and classroom.


Two northern California cities, USA, 2013–2014.


Children aged 2–5 years and their parents.


Relative to control group children, intervention group children reduced their consumption of less-healthy beverages from baseline to follow-up by 5·9 ounces/d (95 % CI −11·2, −0·6) (–174·5 ml/d; 95 % CI –331·2, –17·7) and increased their consumption of healthier beverages by 3·5 ounces/d (95 % CI −2·6, 9·5) (103·5 ml/d; 95 % CI –76·9, 280·9). Children’s likelihood of being overweight decreased by 3 percentage points (pp) in the intervention group and increased by 3 pp in the control group (difference-in-differences: −6 pp; 95 % CI −15, 3).


Our exploratory pilot study suggests that interventions focused comprehensively on encouraging healthier beverage consumption could improve children’s beverage intake and weight. Findings should be confirmed in longer, larger studies.


Corresponding author

*Corresponding author: Email


Hide All
1. Skinner, AC, Ravanbakht, SN, Skelton, JA et al. (2018) Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics 141, e20173459.
2. Must, A & Strauss, RS (1999) Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 23, Suppl. 2, S2S11.
3. Reilly, JJ & Kelly, J (2011) Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 35, 891898.
4. Ebbeling, CB, Feldman, HA, Chomitz, VR et al. (2012) A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med 367, 14071416.
5. de Ruyter, JC, Olthof, MR, Seidell, JC et al. (2012) A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 367, 13971406.
6. Malik, V, Pan, A, Willett, WC et al. (2013) Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 98, 10841102.
7. Auerbach, BJ, Wolf, FM, Hikida, A et al. (2017) Fruit juice and change in BMI: a meta-analysis. Pediatrics 139, e20162454.
8. Sonneville, KR, Long, MW, Rifas-Shiman, SL. et al. (2014) Juice and water intake in infancy and later beverage intake and adiposity: could juice be a gateway drink? Obesity (Silver Spring) 23, 170176.
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, e661e667.
10. Wang, YC, Ludwig, DS, Sonneville, K et al. (2009) Impact of change in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med 163, 336343.
11. Story, M (2013) Recommendations for Healthier Beverages. Princeton, NJ: Robert Wood Johnson Foundation.
12. National Academies of Sciences, Engineering, and Medicine (2017) Strategies to Limit Sugar-Sweetened Beverage Consumption in Young Children: Proceedings of a Workshop. Washington, DC: National Academies Press.
13. Heyman, MB & Abrams, SA (2017) Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics 136, e20170967.
14. Patel, AI, Moghadam, SD, Freedman, M et al. (2018) The association of flavored milk consumption with milk and energy intake, and obesity: a systematic review. Prev Med 111, 151162.
15. Briefel, RR, Wilson, A, Cabili, C et al. (2013) Reducing calories and added sugars by improving children’s beverage choices. J Acad Nutr Diet 113, 269275.
16. Bleich, SN, Vercammen, KA, Koma, JW et al. (2018) Trends in beverage consumption among children and adults, 2003–2014. Obesity (Silver Spring) 26, 432441.
17. Kit, BK, Fakhouri, TH, Park, S et al. (2013) Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr 98, 180188.
18. Kay, MC, Welker, EB, Jacquier, EF et al. (2018) Beverage consumption patterns among infants and young children (0–47.9 months): data from the Feeding Infants and Toddlers Study, 2016. Nutrients 10, 825.
19. ChildCare Aware of America (2018) About child care. (accessed June 2019).
20. Cradock, A, Poole, M, Agnew, K et al. (2019) A systematic review of strategies to increase drinking water access and consumption among 0- to 5-year olds. Obes Rev. Published online: 29 June 2019. doi: 10.1111/obr.12833.
21. Vercammen, K, Frelier, J, Lowery, C et al. (2018) A systematic review of strategies to reduce sugar-sweetened beverage consumption among 0-year to 5-year olds. Obes Rev 19, 15041524.
22. Kenney, EL, Gortmaker, SL, Carter, JE et al. (2015) Grab a cup, fill it up! An intervention to promote the convenience of drinking water and increase student water consumption during school lunch. Am J Public Health 105, 17771783.
23. 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, 365372.
24. Patel, AI, Grummon, AH, Hampton, KE et al. (2016) A trial of the efficacy and cost of water delivery systems in San Francisco Bay Area middle schools, 2013. Prev Chronic Dis 13, E88.
25. Schwartz, AE, Leardo, M, Aneja, S et al. (2016) Effect of a school-based water intervention on child body mass index and obesity. JAMA Pediatr 170, 220226.
26. California Department of Social Services (2018) Child care licensing. (accessed July 2017).
27. Yaktine, A & Moats, S (2011) Child and Adult Care Food Program: Aligning Dietary Guidance for All. Washington, DC: Food and Nutrition Board, Institute of Medicine of the National Academies.
28. Story, M, Kaphingst, KM, Robinson-O’Brien, R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
29. Sallis, J, Owen, N & Fisher, EB (2008) Ecological models of health behavior. In Health Behavior and Health Education: Theory, Research, and Practice, 4th ed., pp. 465485. San Francisco, CA: Jossey-Bass.
30. Environmental Protection Agency (2017) Drinking water requirements for states and public water systems | Lead and copper rule. (accessed May 2018).
31. Brownley, J (2010) Child day care facilities: nutrition. Health and Safety Code, vol. 1596.808. (accessed July 2019).
32. Lee, DL, Gurzo, K, Yoshida, S et al. (2018) Compliance with the New 2017 Child and Adult Care Food Program Standards for Infants and Children before Implementation. Child Obes 14, 393402.
33. Thompson, H, Linchey, J & Madsen, K (2015) Critical elements of a school report to parents on body mass index. Prev Chronic Dis 12, E136.
34. Zamenes, A (2014) Drink More Water! March 2019).
35. Singh, S (2012) Potter the Otter: A Tale About Water. USA: FIRST 5 Santa Clara County.
36. Cole, TJ, Faith, MS, Pietrobelli, A et al. (2005) What is the best measure of adiposity change in growing children: BMI, BMI%, BMI z-score or BMI centile? Eur J Clin Nutr 59, 419425.
37. Berkey, CS & Colditz, GA (2007) Adiposity in adolescents: change in actual BMI works better than change in BMI z-score for longitudinal studies. Ann Epidemiol 17, 4450.
38. Centers for Disease Control and Prevention (2007) National Health and Nutrition Examination Survey (NHANES) Anthropometry Manual. Atlanta, GA: CDC.
39. Centers for Disease Control and Prevention, National Center for Health Statistics (2000) CDC Growth Charts: United States. Atlanta, GA: CDC.
40. Grummon, AH, Hampton, KE, Hecht, A et al. (2017) Validation of a brief questionnaire against direct observation to assess adolescents’ school lunchtime beverage consumption. J Nutr Educ Behav 49, 847851.e1.
41. Ward, D, Hales, D, Haverly, K et al. (2008) An instrument to assess the obesogenic environment of child care centers. Am J Health Behav 32, 380386.
42. Birch, L, Parker, L & Burns, A (editors) (2011) Early Childhood Obesity Prevention Policies. Washington, DC: National Academies Press.
43. Kenney, EL, Long, MW, Cradock, AL et al. (2015) Prevalence of inadequate hydration among US children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009–2012. Am J Public Health 105, e113e118.
44. Benton, D & Burgess, N (2009) The effect of the consumption of water on the memory and attention of children. Appetite 53, 143146.
45. D’Anci, KE, Constant, F & Rosenberg, IH (2006) Hydration and cognitive function in children. Nutr Rev 64, 457464.
46. Masento, NA, Golightly, M, Field, DT et al. (2014) Effects of hydration status on cognitive performance and mood. Br J Nutr 111, 18411852.
47. Edmonds, CJ & Jeffes, B (2009) Does having a drink help you think? 6–7-year-old children show improvements in cognitive performance from baseline to test after having a drink of water. Appetite 53, 469472.
48. US Department of Health and Human Services & US Department of Agriculture (2015) Dietary Guidelines for Americans 2015–2020, 8th ed. Washington, DC: USDA and HHS.
49. Marshall, TA, Levy, SM, Broffitt, B et al. (2003) Dental caries and beverage consumption in young children. Pediatrics 112, e184e191.
50. Malik, VS, Popkin, BM, Bray, GA et al. (2010) Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 33, 24772483.
51. Vos, MB, Kaar, JL, Welsh, JA et al. (2017) Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 135, e1017e1034.
52. US Department of Agriculture (2018) Supertracker | Food-A-Pedia. (accessed June 2018).
53. Wang, YC, Hsiao, A, Orleans, CT et al. (2013) The caloric calculator: average caloric impact of childhood obesity interventions. Am J Prev Med 45, e3e13.
54. Bluford, DAA, Sherry, B & Scanlon, KS (2007) Interventions to prevent or treat obesity in preschool children: a review of evaluated programs. Obesity (Silver Spring) 15, 13561372.
55. Glasgow, RE, Vogt, TM & Boles, SM (1999) Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 89, 13221327.
56. Alkon, A, Crowley, AA, Neelon, SEB et al. (2014) Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index. BMC Public Health 14, 215.
57. Fitzgibbon, ML, Stolley, MR, Schiffer, L et al. (2005) Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children. J Pediatr 146, 618625.
58. Eliakim, A, Nemet, D, Balakirski, Y et al. (2007) The effects of nutritional–physical activity school-based intervention on fatness and fitness in preschool children. J Pediatr Endocrinol Metab 20, 711718.
59. Puder, JJ, Marques-Vidal, P, Schindler, C et al. (2011) Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ 343, d6195.
60. Zask, A, Adams, JK, Brooks, LO et al. (2012) Tooty fruity vegie: an obesity prevention intervention evaluation in Australian preschools. Health Promot J Aust 23, 1015.
61. De Coen, V, De Bourdeaudhuij, I, Vereecken, C et al. (2012) Effects of a 2-year healthy eating and physical activity intervention for 3–6-year-olds in communities of high and low socio-economic status: the POP (Prevention of Overweight among Pre-school and school children) project. Public Health Nutr 15, 17371745.
62. Herman, A, Nelson, BB, Teutsch, C et al. (2012) ‘Eat healthy, stay active!’: a coordinated intervention to improve nutrition and physical activity among head start parents, staff, and children. Am J Health Promot 27, e27e36.
63. Yin, Z, Parra-Medina, D, Cordova, A et al. (2012) Míranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention. Child Obes 8, 429439.
64. Zhou, Z, Ren, H, Yin, Z et al. (2014) A policy-driven multifaceted approach for early childhood physical fitness promotion: impacts on body composition and physical fitness in young Chinese children. BMC Pediatrics 14, 118.
65. Salazar, G, Vasquez, F, Concha, F et al. (2014) Pilot nutrition and physical activity intervention for preschool children attending daycare centres (JUNJI): primary and secondary outcomes. Nutr Hosp 29, 10041012.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Grummon et al. supplementary material
Grummon et al. supplementary material

 Word (40 KB)
40 KB

Effects of a multipronged beverage intervention on young children’s beverage intake and weight: a cluster-randomized pilot study

  • Anna H Grummon (a1) (a2), Michael D Cabana (a3) (a4) (a5), Amelie A Hecht (a6), Abbey Alkon (a7), Charles E McCulloch (a5), Claire D Brindis (a3) (a4) (a8) and Anisha I Patel (a9)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.