Childcare Healthy Beverage Access, Food and Beverage Intake, and Obesity

Healthy Drinks, Healthy Futures: The Impact of a Childcare-based Healthy Beverages Intervention on Young Children's Food and Beverage Intake and Obesity

Interventions that promote water consumption in place of sugar-sweetened beverages have shown promise for preventing childhood obesity in schoolchildren. Yet to date, no studies have examined whether applying this approach in childcare centers could help to prevent childhood obesity at an even earlier stage of development. This cluster-randomized controlled trial will fill gaps by examining how a multilevel childcare-based healthy beverage intervention affects young children's consumption of beverages and obesity.

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Behavioral: Healthy Drinks, Healthy Futures

Detailed Description

There is little debate that sugar-sweetened beverages (SSBs; drinks with added sugar) lack nutrition, are a major source of added sugar and calories, and promote obesity and poor cardiometabolic health, especially when consumed during early childhood. Nearly half of children aged 2-5 drink SSBs on a daily basis, with heavier consumption in low-income Latino children. After decades of research, it is clear that there is no single "magic bullet" for solving obesity. What we need are bundled interventions that combine incremental changes that transform food environments with targeted behavior changes that steer people towards those healthy options. Childcare centers, which serve 12.5 million children per year, provide an efficient way to intervene early by engaging childcare providers and parents to make resonant, mutually reinforcing changes in both the home and childcare environment. Interventions that promote water consumption in place of SSBs have shown promise for preventing childhood obesity in schoolchildren. Yet, no studies have examined whether interventions to promote intake of water instead of SSBs in childcare could prevent childhood obesity at an even earlier stage of development. The proposed cluster-randomized controlled trial will test the efficacy of an intervention called Healthy Drinks, Healthy Futures (Bebidas Saludables, Futuros Saludables) that is culturally adapted for Latino children and families. Following the Social-Ecological Model and Social Learning Theory, the intervention supports complementary changes in the childcare and home food environments that promote water consumption while reducing SSB availability. This is combined with education for childcare providers and children, and a one-on-one brief motivational counseling intervention with parents to reduce SSB intake and encourage water consumption in the home. Fourteen childcare centers serving low-income, predominately Latino children (n=420) will participate in this trial. The primary outcome is child BMI z-score (BMI standard deviation score). Key secondary outcomes are intake of water and beverage calories at centers and at home. Outcomes will be captured using anthropometrics (weight, height), and beverage frequency questionnaires at baseline, 6-months, and ~12-months post-intervention. Plate waste measurements (water and caloric intake at centers) and Automated Self-Administered 24-hour dietary recalls (water and caloric intake at home) will occur at baseline and 12 months post-intervention. Surveys of childcare providers and parents will allow us to explore possible mediators of the intervention effect. We hypothesize that the childcare-based healthy beverage intervention will increase intake of water and reduce beverage calories consumed at both childcare and at home. BMI z-score will also improve among children in intervention centers vs. control centers. If shown to be effective, the Healthy Drinks, Healthy Futures intervention will offer a strategy for intervening early to prevent obesity for millions of low-income children attending childcare centers. Findings from this study will contribute to the science of multilevel obesity prevention, and inform the implementation of state, federal, and local policies to promote healthy beverage intake in childcare centers.

• Study Type: Interventional
• Enrollment (Actual): 1034
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Stanford, California, United States, 94305-5119
      • Stanford

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 101 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Preschool-age children and families who don't have health conditions that preclude intake of water

Exclusion Criteria:

• Children not of preschool-age
• Children and families who do not speak English or Spanish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Usual care.
Experimental: Healthy Beverage Access and Promotion; Intervention group will receive pitchers, water bottles, and cups for serving water at mealtimes and throughout the day, individualized education to help families set healthy drinks goals for their family, and a curricula focused on increasing intake of water and healthy beverages.	Behavioral: Healthy Drinks, Healthy Futures; The Healthy Drinks, Healthy Futures intervention consists of increased access to and promotion of healthy beverages in childcare centers and education directed to children and their families to increase the intake of healthy beverages, including motivational beverage counseling for families and lessons for children in childcare centers.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in BMI Z-score	Trained research staff measure children's heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. BMI z-scores (or standard deviation scores) are used to quantify how far a child's anthropometry measurement deviates from the median of a reference population. The score is calculated using the sex, age, weight, and height of the participant, and is based on growth references for children. A z-score of 0 reflects the 50th percentile (the median) of the reference growth charts. For example, a z-score of 1.5 indicates a child is 1.5 standard deviation units above the reference median, whereas a z-score of -1.5 means a child is 1.5 below it, adjusting for childhood BMI distributions.	Baseline, 6-months, and 10-months after the start of the study.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Caloric Intake From Beverages at Childcare Centers	Trained research staff conduct two day-long plate waste measurements per center. Beverages are weighed before and after intake.	Baseline and 10-months after the start of the study.
Total Caloric Intake From Beverages Outside of Childcare Centers	Calorie content of beverages consumed outside of childcare centers derived from ASA24® nutrient database.	Baseline and 10-months after the start of the study.
Total Water Intake From Beverages at Childcare Centers	Trained research staff conduct two day-long plate waste measurements, per center. Water is weighed before and after intake.	Baseline, and 10-months after the start of the study.
Total Water Intake Outside of Childcare Centers	Water intake outside of childcare centers derived from ASA24® nutrient database.	Baseline, and 10-months after the start of the study.
Beverage Intake	Beverage intake frequency questionnaire (BEVQ PS) used to calculate past-week frequency of beverages consumed (ounces/day).	Baseline, 6-months, and 10-months after the start of the study.

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); University of California, Davis; University of California, San Francisco
• Investigators: Principal Investigator: Anisha Patel, MD, MSPH, Stanford University

Study record dates

Study Major Dates

• Study Start (Actual): October 19, 2022
• Primary Completion (Actual): August 12, 2025
• Study Completion (Actual): September 1, 2025

Study Registration Dates

• First Submitted: October 27, 2021
• First Submitted That Met QC Criteria: October 27, 2021
• First Posted (Actual): November 8, 2021

Study Record Updates

• Last Update Posted (Actual): September 1, 2026
• Last Update Submitted That Met QC Criteria: August 11, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: sugar-sweetened beverages; water; childcare
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Obesity
• Other Study ID Numbers: 61606; 1R01DK127124-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No