A community movement brought to you by… Water First for Thirst A community movement brought to you by… Water First for Thirst is more than just a message, it is a movement. A movement to make water the easy choice, the appealing choice and the first choice for children and families in our community.

Water First for Thirst It’s good for you… It’s good for our community… Together, we can make water the easy choice! Click for animation: In the next 15 minutes, I will share with you why Water First for Thirst is good for your organization and good for our community. We will see several examples of how other organizations in our community have encouraged water first for thirst. Finally, I will show you simple changes you can make to make water the easy choice for the children and families you serve .

Water First for Thirst Everything a body needs… Skin Muscles Brain Digestive system Kidneys Water is the original sports drink – every system in our body depends on water to function optimally. Our skin, muscles, brain, digestive system, kidneys etc. all work at their best when we drink water

Water First for Thirst …and nothing it doesn’t. No sugar No fat/cholesterol No added sodium No artificial additives Together, we can make water the easy choice! Water is naturally free of the nutrients we want to consume less of too.

50 gallons of sugary drinks What Are We Drinking? 50 gallons of sugary drinks = 38 pounds of sugar Source: Ogden et al. Consumption of Sugar Drinks in the United States 2005-2008 The average American drinks about 50 gallons of sugary drinks annually. That adds up to about 38 pounds of sugar in a year! Sugary beverages are the number one source of calories in the American diet. The Ohio Department of Health describes sugary beverages as: pop, soda, sweetened powder drink mixes (ex. Kool-aid/lemonade) Sunny Delight, Hawaiian Punch, Gatorade, energy drinks (not including diet drinks) One 20 ounce bottle of soda contains about 16 teaspoons of sugar. Resources: Ogden CL, Kit, BK, Carroll MD, Park, S. Consumption of Sugar Drinks in the United States, 2005-2008. NCHS data brief, no71. Hyattsville, MD: National Center for Health Statistics. 2011. Division of Nutrition and Physical Activity. Research to Practices Series No. 3: Does Drinking Beverages with Added Sugars Increase the Risk of Overweight? Atlanta: Centers for Disease Control and Prevention, 2006.

What Are We Drinking? In 2002, 44% of toddlers, 19–24 months old consumed at least one sugary drink every day. Source: Centers for Disease Control and Prevention, 2006. In 2002, The FITS study found that almost half of children ages 19-24 months consumed sugar sweetened beverages at least once per day. Resources: Ogden CL, Kit, BK, Carroll MD, Park, S. Consumption of Sugar Drinks in the United States, 2005-2008. NCHS data brief, no71. Hyattsville, MD: National Center for Health Statistics. 2011. Division of Nutrition and Physical Activity. Research to Practices Series No. 3: Does Drinking Beverages with Added Sugars Increase the Risk of Overweight? Atlanta: Centers for Disease Control and Prevention, 2006.

What Are We Drinking? In 2009/2010, about 40% of Ohio’s 3rd graders drank 2 or more sugary drinks each day. Ohio Department of Health, A Report on the Body Mass Index of Ohio’s Third Graders 2004–2010 In the 2009/2010 school year, approximately 40% of Ohio’s 3rd graders were drinking 2 or more sugar sweetened beverages each day.

The Effects… Soft drinks are the food category most strongly linked to increased risk of obesity and diabetes. A systematic review of more than 88 studies found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes). Other Findings: Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non-industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007 Apr;97(4):667-75. Epub 2007 Feb 28. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007 Apr;97(4):667-75. Epub 2007 Feb 28.

The Effects… For adults…. Drinking one or two sugary drinks each day increases the risk of developing type 2 diabetes by 25%. Malik VS, et al. Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2Diabetes. Diabetes Care. 2010; 33:2477–2483 So what effect does all this sugar have? Review slide….

The Effects… For children….. every sugary drink they drink each day, increases their likelihood of developing obesity during childhood by about 60%. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001; 357: 505–08. So what effect does all this sugar have? For every 1 sugary drink a child drinks each day, their likelihood of developing obesity during their childhood goes up by about 60%. The OHIO DEPARTMENT OF HEALTH’s Report on the Body Mass Index of Ohio’s Third Graders 2004–2010 reinforced this research, finding that children who regularly consumed more than 1 sugar sweetened beverages per day were more likely to be at an unhealthy weight than those who drank fewer SSBs. According to the 2008-09 Ohio Family Health Survey, compared to healthy weight children, Ohio’s children with obesity are 4.6 times more likely to have diabetes 1.8 times more likely to have asthma 2 times more likely to have poor health status Source: Ohio Family Health Survey, 2008-09

In Columbus… CCS has been collecting height and weight data at entry to kindergarten, 3rd grade and 5th grade since the 2007/2008 school year. As you can see from the kindergarten statistics, a significant number of children are entering school at an unhealthy weight. This data also warns us that this health risk isn’t something that the kids are simply outgrowing. By 3rd grade more than 35% of children are at an unhealthy weight. And by 5th grade, almost 45% of children are at an unhealthy weight. This suggests that the habits contributing to unhealthy weights, including SSB consumption, likely start much earlier than 3rd grade. A few notes about Columbus City Schools: Columbus City Schools is the largest school district in Columbus, Ohio serving approximately 52,851 PreK-12 students. (60% African American, 27.7% white, 6.1% Hispanic, 4.5% multi About 1 of every 3 children will enter kindergarten at an unhealthy weight.

Kids (2-7years old) see about 12-21 food commercials per day. Giving water a chance… The food industry spends about $2 billion/year marketing foods to children. Sugary drinks Fast foods, cereals and snacks Kids (2-7years old) see about 12-21 food commercials per day. Source The Weight of the Nation. Marketing Food to Children. Rudd Radar, Food Marketing to Youth: The Best and Worst of 2012 . Dec 19, 2012. Why do we need to do more than educate children and families? Let’s look at what our message “water first for thirst” competes against in our culture…. The food industry spends two billion dollars per year marketing to young people. The majority of the food items advertised to children are high in fat, sugar, calories and sodium, while being low in healthy nutrients. Only $11.4 million (<1% total) was spent on marketing fruits and vegetables to children in 2006, It is estimated that children between the ages of two and seven view 12 to 21 food commercials on TV every day. This equates to 4,440 to 7,600 commercials per year. Studies suggest that food marketing to youth increases: preferences for the advertised item, consumption of the item, total calorie intake, and requests to parents to purchase the item. (this is often referred to as the “nag factor”). This is why “water first for thirst” has to be more than a slogan. The playing field isn’t even – our message simply can’t compete in this world of high-powered advertising. We have to make it easier and more appealing for our children and families to choose water first. Resources: The Weight of the Nation. Marketing Food to Children. http://theweightofthenation.hbo.com/themes/marketing-food-to-children Rudd Radar, Food Marketing to Youth: The Best and Worst of 2012 . Dec 19, 2012. http://www.yaleruddcenter.org/food-marketing-to-youth-the-best-and-the-worst-of-2012

Making Water the Easy Choice in Our Community... While the issue of obesity, especially childhood obesity, is complex and requires many changes at many levels, it is clear that reducing the number of SSB children are consuming is an important component of any effort to improve health and reduce weight-related illness. But we are making progress. Many of our local organizations have implemented policy, system and environmental changes that are making it easier for children and families to choose water.

What Can You Do? Commit to making the healthy choice the easy choice….. “Behind every child raising a sugar sweetened beverage to their lips, there are adults that let it be there, priced it or advertised it.” Carol Smathers MA MPH, Field Specialist, Youth Nutrition and Wellness, OSU Extension Family and Consumer Sciences While it is true that parents are ultimately the decision makers about what their children eat and drink, the choices parents and children make are shaped by the choices they have. Every time a child eats of drinks something – healthy or not, there are many adults who affected their choice. Adults make decisions about what messages children see, what foods they can choose from and the financial and societal costs of that food. By changing your policies, by writing down and committing to a change in the environment in which you serve your customers, you can help make the healthy choice the easy choice.

What Can You Do? Make Water the Easy Choice. Serve only water Pricing strategies Vending machine placement Limit portion sizes Every organization is unique and there are a variety of different ways you can make water the easy choice. When freely serving beverages at events and meetings, serve only water. Make water free or at least cheaper relative to other beverages Replace at least ½ (or all) of the sugary drinks for sale in vending machines and foodservice with water. Place other beverages in the very top and very bottom rows and fill the others with water. Limit the portion sizes of sugary beverages that can be served/sold in your facility. (example: only 12 ounce cans and no 16 or 20 ounce bottles)

What Can You Do? Change the Message You Send Limit logos Be selective about sponsors Add “Water First for Thirst” Model drinking water Eliminate ads and logos for sugary drinks. Avoid taking money, resources and product donations from beverage companies. Add the Water First for Thirst messages to your own marketing efforts. CPH’s website has lots of great resources. Show people drinking water in your ads – even for other things

Our Community… Community Development for All People Water will always be available whenever other beverages such as coffee, tea, 100% fruit juice and/or milk are offered. Community Development for All People Will serve only water or unsweetened beverages for any meals or events. Will not serve sugar sweetened beverages (e.g., fruit punch, soda, flavored drinks) at any meal or event. In 2012, Columbus Public Health partnered with 10 community organizations and agencies to create a healthier environment. Of those 10 organizations, 8 established policies and environments specifically intended to make water the easy choice for their clients and visitors. Let’s review how they did it….. (review slide content)

Our Community… YMCA Eldon Ward Made water freely available and encouraged whenever beverages are offered. A water dispenser is available at all special events where beverages are served. Only water, 100% fruit juice or fat-free or 1% milk are served at Eldon Ward YMCA events. Located a water dispenser next to the coffee pot.

Our Community… Central Community House Made water freely available whenever beverages are offered. Columbus Urban League Head Start Water will be freely available and encouraged whenever beverages are offered. Water dispensers are available in every classroom – effective October 2011. A water dispenser is available for all special events where beverages are served. Head Start Academy classrooms serve only water, 100% fruit juice or fat-free or 1% milk. No sugar sweetened beverages such as lemonade, sodas, sports drinks or juice drinks will be served.

Our Schools… Since 2009, all beverage vending machines located in student areas of Columbus City Schools have sold only water. In 2009/2010, Columbus City Schools stepped up as a leader in making water the easy choice for students by implementing a water-only vending policy. Since 2009, beverage vending machines accessible to students in CCS have stocked nothing but water.

Our Healthcare… In the first quarter of 2011 – Nationwide Children’s Hospital eliminated all sugary drinks from their facilities and property, including Cafeteria and Gift Shops Food Court (includes Subway and Koko’s) All Vending (including off sites) Patient and Family Food Menus They also reduced the price of water. In 2011, NCH took a slightly different approach. They eliminated the sale of sugary drinks in all vending, foodservice and patient meals. At that time they also reduced the price of water to make it more competitive in sales. NCH does allow some exceptions Physicians/ residents/ nurses may order soda for patients (clinical reasons) Families, visitors, staff may bring SSBs to campus

2.72%* NCH was able to document that not only did they not lose revenue with this change – they actually saw a net increase of 2.72% in beverage sales after eliminating sugary beverages. NCH also was able to document that milk and water sales increased, suggesting that when sugary drinks were less readily available, consumers began to choose more healthful beverage options. * Percent Change 2010 to 2011

Our Government… In 2012, Columbus Public Health Required vending machines to have at least 50% of slots filled with water. Eliminated all sugary drinks from vending machines. Reduced the price of water (relative to diet sodas). Established healthy meeting guidelines for serving only water, coffee, tea and skim/1% milk at meetings and events. In 2012, Columbus Public Health followed a similar plan and eliminated the sale of sugary drinks in all vending machines and made water less expensive than diet drinks.

Our Parks… Columbus Recreation and Parks CAP City Nights and APPS events: Will not serve sugar-sweetened beverages. Only water, unflavored skim or 1% milk or 100% fruit juice will be offered. In 2013, Columbus Recreation and Parks course catalogs will feature a logo for a water product. instead of a sugar-sweetened beverages. Note: APPS (Applications for Purpose Pride and Success) is a violence prevention and intervention program aimed at reducing the incidence of gang-involved shootings and youth homicides in Columbus neighborhoods. The APPS program operates at four Recreation centers in the city, offering activities and intervention for youth and young adults.

Be a Water First for Thirst Partner Do you need help to make water the easy and appealing choice? Columbus Public Health can help! Contact: Healthy Children, Healthy Weights (614) 645-7520 publichealth.columbus.gov/healthy-children-healthy-weights.aspx