Think AHEAD (A Healthy Eating And Drinking) Study

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01044134
Recruitment Status : Terminated (We achieved n=38, due to slow recruitment (=2/3 of target).)
First Posted : January 7, 2010
Last Update Posted : July 29, 2015
Information provided by (Responsible Party):
David S. Ludwig, MD, PhD, Boston Children’s Hospital

January 5, 2010
January 7, 2010
July 29, 2015
February 2011
June 2014   (Final data collection date for primary outcome measure)
Body mass index [ Time Frame: 6 month change ]
Body weight [ Time Frame: 6 month change ]
Complete list of historical versions of study NCT01044134 on Archive Site
  • Body fat percentage [ Time Frame: 6 month change ]
  • Body circumferences [ Time Frame: 6 month change ]
  • Urine specific gravity [ Time Frame: Change throughout 6 months ]
  • Hunger, satiety, and palatability ratings [ Time Frame: 6 month change ]
  • Diet quality [ Time Frame: 6 month change ]
  • Satisfaction rating [ Time Frame: 6 months ]
  • Immune status [ Time Frame: 6 month change ]
  • Cardiovascular risk factors [ Time Frame: 6 month change ]
  • Diabetes risk factors [ Time Frame: 6 month change ]
  • Body fat percentage [ Time Frame: 6 month change ]
  • Body circumferences [ Time Frame: 6 month change ]
  • Urine specific gravity [ Time Frame: Change throughout 6 months ]
  • Hunger rating [ Time Frame: 6 month change ]
  • Diet quality [ Time Frame: 6 month change ]
  • Satisfaction rating [ Time Frame: 6 months ]
Not Provided
Not Provided
Think AHEAD (A Healthy Eating And Drinking) Study
A 6-Month Study on Diet and Weight Loss in Overweight Adolescents

Advice to increase water consumption as part of a weight-reducing diet - typically to 8 cups (64 fl oz, ~2 L) per day ("8x8" water recommendation) - is almost ubiquitously recommended by healthcare professionals. Many believe that water promotes weight loss through numerous physiological mechanisms. However, only limited observational data and virtually no experimental data exist regarding the effects of water consumption on body weight. In this study, we propose a randomized controlled pilot study in which two groups of overweight adolescents will receive a standard weight loss regimen, either with (experimental intervention) or without (control intervention) additional advice and support to increase water consumption. We will utilize individual sessions, an innovative text messaging protocol, and motivational telephone calls to promote adherence to the interventions. The purpose of this pilot study is to evaluate feasibility and obtain preliminary efficacy data, to inform design of a future, definitive study.

It is hypothesized that increasing water consumption will improve the efficacy of a standard weight-reducing diet and will lead to decreased consumption of energy-containing beverages, decreased total energy intake, improved diet quality, improved immune status, and improved cardiovascular and diabetes risk factors. This simple behavioral intervention will be feasible and will significantly increase water consumption among participants in the experimental vs. control group.

This is a 6-month randomized controlled trial. After the initial baseline screening and assessments, 60 overweight adolescents will be randomly assigned (30 subjects per group) to a standard weight-reducing diet with the advice to consume 8 cups of water per day (experimental group) or the same standard weight-reducing diet without additional advice (control group). The interventions will consist of nutrition education and behavioral counseling by a registered dietitian, during individual sessions and telephone calls. Mobile text messaging will be used to reinforce information presented at the individual sessions and thereby foster adherence to dietary advice. Diet prescriptions will differ only in regard to the specificity of recommendations regarding water consumption and physical activity recommendations will not differ between groups. The frequency and content of text messages will be consistent between the experimental and control groups, with the exception that the experimental group will receive an additional phrase with each message to encourage the "8 x8" water recommendation.

A registered dietitian will communicate with each participant one time per month, either during an individual session or by telephone. Individual sessions will include nutrition classes, taste testing, hands-on activities, and opportunities for questions and answers. Text messages will be sent on a daily basis.

Study outcomes will be assessed at baseline and at regular intervals throughout the 6 months of the study.


The blinding of the randomization will be broken on or after July 28, 2014 and the data will be analyzed according to the following plan. All analyses will follow the intention-to-treat principle, attributing each subject to his or her assigned diet regardless of compliance. Baseline characteristics will be compared between the diet groups using the Fisher exact test for categorical variables and t-test for continuous variables. The 6-month change from baseline in the primary and secondary outcomes will be compared between groups using a general linear model, adjusting for baseline covariates that are potentially correlated with the outcome. These include demographics, socioeconomic status, anthropometrics, physical activity, and beverage consumption. We will further test covariates for potential interaction, i.e., differential effect on outcome in the two trial arms. The null hypothesis is that the 6-month change from baseline will not differ between diet groups.

Not Applicable
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Behavioral: Dietary counseling
Participants will receive personalized dietary counseling to promote behavior change
  • Experimental: Diet + Water
    Participants will be counseled to follow a standard weight-reducing diet including consumption of 1) ample vegetables, fruits, and legumes; 2) whole rather than refined grains; and 3) high-quality proteins at most meals and snacks. Moreover, we will recommend limiting intake of added fats and sugars and avoiding juices and sugar-sweetened beverages (per standard practice). Participants will also be counseled to increase their water intake to 8 cups per day, consistent with the popular "8 × 8" recommendation (eight 8-oz glasses of water).
    Intervention: Behavioral: Dietary counseling
  • Active Comparator: Diet
    Participants will be counseled on the same standard weight-reducing diet, as described above, with no specific advice regarding water consumption. Furthermore, no specific dietary recommendations will be provided on altering fluid/beverage intake, other than to decrease calorie-containing beverages as noted above. When participants ask for a recommendation regarding water intake, they will be advised that drinking plain water is the best way to satisfy thirst and instructed to drink when thirsty.
    Intervention: Behavioral: Dietary counseling
Wong JMW, Ebbeling CB, Robinson L, Feldman HA, Ludwig DS. Effects of Advice to Drink 8 Cups of Water per Day in Adolescents With Overweight or Obesity: A Randomized Clinical Trial. JAMA Pediatr. 2017 May 1;171(5):e170012. doi: 10.1001/jamapediatrics.2017.0012. Epub 2017 May 1.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
June 2014
June 2014   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • BMI ≥ 85th percentile for sex and age according to CDC growth charts
  • Access to a working telephone and cell phone
  • At least one parent willing and able to participate in the intervention with the subject
  • Residing in predominately one household (no more than one weekend every two weeks in a secondary household)
  • Medical clearance from a primary care provider or treating physician to rule out any major medical illness, disability, or disorder (e.g., liver disease, renal failure, cancer)

Exclusion Criteria:

  • Intake of more than 4 cups (250 mL per cup) of water per day
  • BMI ≥ 40 kg/m2
  • Currently smoking (> 1 cigarette in the past week)
  • Major surgery within the previous 6 months
  • Does not have a primary care provider
  • Physician diagnosis of a major medical illness (e.g. diabetes)
  • Previous diagnosis of an eating disorder
  • Physical, mental, or cognitive handicaps that prevent participation
  • Chronic use of medications that may affect study outcomes (e.g. stimulants or diuretics)
  • Another member of the family (first degree relative) or household participating in the study
  • A friend, classmate or coworker participating in the study with whom they have contact with one or more times per week
  • Girls who are pregnant, planning to become pregnant in the next 6 months, lactating, or within 6 months postpartum
Sexes Eligible for Study: All
12 Years to 17 Years   (Child)
Contact information is only displayed when the study is recruiting subjects
United States
Not Provided
Not Provided
David S. Ludwig, MD, PhD, Boston Children’s Hospital
Boston Children’s Hospital
Not Provided
Principal Investigator: David S Ludwig, MD, PhD Boston Children’s Hospital
Boston Children’s Hospital
July 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP