03 Dec 2019

Dietitian Chris Cheyette, and Water for London campaigner Justine Rose, explore how we can all encourage the increased consumption of tap water as our preferred cold drink

Writer info

Chris Cheyette Diabetes Specialist Dietitian at King’s College Hospital and author of the bestselling Carbs & Cals series of books.

Justine Rose Passionate blogger (littlegreenduckie.com) on all things sustainability. Challenges rail companies on water fountains, book swap guardian, loves a litter pick.


The European Food Safety Authority sets the Adequate Intake (AI) for total water (from all sources including food) intake at 2.5 L/day for males and 2.0 L/day for females.1


Many people are not consuming enough fluid. The Natural Hydration Council commissioned a survey of 300 GPs. It suggested that dehydration can be attributed to 10% (UK average) of consultations for tiredness and fatigue. This rises to 15-20% in London, East Anglia and Wales. In more than one-third of cases, patients reported feeling better after drinking more healthy fluids. Only 4% of GPs strongly agreed that patients are aware of how to hydrate healthily.2

The plastic tide

Currently every minute, one million plastic bottles are bought around the world, and that figure is expected to go up 20% by 2021.3 In the UK alone, we consume 13 billion plastic bottles a year – 7.7 billion of them are plastic water bottles.4

As we saw in the previous article in Dietetics Today (July-August edition) nearly half of those bottles are not recycled, with more than 15 million littered, landfilled or incinerated every day4 , and producing 233,000 tonnes of CO2 emissions a year.5 We have already seen that more needs to be done to ensure these valuable resources do not fall out of the recycling system – those bottles that do end up on the streets or thrown from car windows may make their way into our oceans. Plastic bottles comprise one-third of all plastic pollution in the sea.6

Barriers and solutions

Remembering a bottle – It can be hard for people to change their habits. On average, UK adults buy 2.8 plastic water bottles per week.7 The motivation of saving money could help. Suggest putting £1 in a pot every time they remember their bottle to help visualise the savings and help future motivation.

Taste – Some people don’t like the taste of plain water. A filter jug in the fridge or an under sink filter unit could make the water taste more palatable both at home, and filling a bottle to take out. There are also ‘infuser’ bottles, these have a built in cage for fruit or herbs – allowing the flavour of the item to infuse the water during the day. Examples could be; cucumber, mint, strawberry, grape.

Discourage regular use of citrus fruit as this could weaken teeth enamel over time. If purchasing sparkling water, make sure to purchase UK-produced water in glass bottles as this can be recycled after use and so is the most sustainable option.8

Hygiene & water contaminants – The Drinking Water Inspectorate independently checks the tests water companies carry out on a daily basis, and audits water company laboratories. If any one of the millions of tests each year fails the standards then the inspectors use their powers to require the water company to make the necessary improvements to drinking water quality.9

As treatment is essential for public health, tap water, in the UK, is more closely tested than bottled water.10

Fluoride – People may be concerned around the fluoridation of their tap water. This is not added by the water company, but by the local health authority to help reduce tooth decay. However, fluoride does occur naturally (at lower levels) in soils and rocks and can therefore be found in untreated water.

The concentration of fluoride depends on the type of soil and rock the water passes through.11 So you can answer queries from clients on this, it might be useful to check if your local health authority does add fluoride or not. If people wish to avoid added fluoride then they will need to investigate suitable filters.

Chlorine – This has been used in the UK for many years to disinfect water from water borne pathogens. The level of chlorine in drinking water is strictly controlled to 1 milligram per litre. It can leave a slight taste residue that some people don’t like but it is perfectly safe to drink. If people feel that they wish to avoid this residue, then again suitable filters are an option.

Safety of public refill points – Legally, the relevant water supply company has to approve all installations, and ensure the equipment being used meets UK regulations for safety.12 The company selling, or renting the equipment will include maintenance within the contract.

Availability of toilets – People may be concerned about finding a toilet if they are drinking more water. If going somewhere new, or unfamiliar, then The Great British Public Toilet Map (toiletmap.org.uk) can provide reassurance as to where the nearest one will be.

Availability of water points – 62% of adults say they wouldn’t buy bottled water if tap water was more freely available,13 but most people don’t know how to access it. However, things are changing, the UK Government’s 2018 25-year Environment Report stated they would be “Supporting water companies, high street retailers, coffee shops and transport hubs to offer new refill points for people to top-up water bottles for free in every major city and town in England. The water industry plans to create a nationwide network of refill points, and an app to help people find the nearest place to refill their bottles with water free of charge.”14

Refill is an award-winning campaign, working with local water companies, to prevent plastic pollution at source. The aim is to make it easier to reuse and refill a water bottle on the go rather than buy a single-use plastic bottle.

The campaign works by connecting people looking for water with thousands of Refill stations across the UK via a location-based app. Anyone can download the free app and find Refill stations where they can fill up for free on the go.

Participating cafes, bars, restaurants, banks, galleries, museums and other businesses simply sign up to the app and put a sticker in their window. The sticker alerts passers-by that they’re welcome to come in and fill up their bottle. There are currently more than 17,500 Refill stations in the UK and over 100,000 app downloads.

The app also includes public water fountains in stations, airports, parks and shopping centres. These are especially helpful for the 90% people who don’t feel comfortable asking for their bottle to be refilled in a business, if they are not making a purchase.15

BDA office staff recently teamed up with their local water provider Severn Trent to promote Refill in Birmingham. With other volunteers we signed up 30 new businesses and spoke to dozens more to raise awareness of the scheme.

Water for London is campaigning for all of London’s (and beyond) transport stations to have public water fountains, in addition to businesses offering refill. They maintain a list of stations and airports across the UK that currently have a public water point at waterforlondon.org/wheresmywaterfountain

How dietitians can help

Dietitians are expertly placed to be advocates for public health on both individual and population level to influence clients to choose water as their go-to cold drink through consistent advice and messaging; ways of doing this include:

  • discussion about healthy hydration as part of your consultations
  • keep a reusable water bottle on your desk, normalise the behaviour; use this to demonstrate how much water the client should be drinking per day
  • download the Refill app and be ready to advise clients which businesses offer Refill and where the public water fountains are in your town
  • when using public transport, take a ’thirsty selfie’ at the station with your reusable bottle; post the selfie to social media of your choice and tag the transport company and ask #WheresMyWaterFountain?

Many towns and cities also have a Refill group. These volunteers help sign more businesses up to the scheme and run events to promote the scheme. Check out refill.org.uk/refill-schemes for your local one, or how to start one.




  • Currently every minute, one million plastic bottles are bought around the world
  • Half of all plastic bottles bought are not recycled
  • Plastic bottles comprise one-third of all plastic pollution in the sea
  • As treatment is essential for public health, tap water, in the UK, is more closely tested than bottled water



1. European Food Safety Authority (EFSA). Scientific Opinion on Dietary Reference Values for water. EFSA Journal. 2010;8(3):1459. Available from: efsa.europa.eu/en/efsajournal/ pub/1459

2. GP’s reveal tired all the time (2015) available from; naturalhydrationcouncil.org.uk/ press/gps-reveal-uk-tired-all-the-time/

3. Euromonitor International’s global packaging trends report, available from; go.euromonitor. com/00-EV-APAC2017-AUSPACK_ Landing-Page.html

4. RECycling of Used Plastics Limited, 2017 RECOUP Household Collection Survey (June 2017)

5. Eunomia Research & Consulting Ltd (PKG0086A) cited in: House of Commons, ‘Plastic bottles: Turning Back the Plastic Tide’ available from: publications.parliament. uk/pa/cm201719/cmselect/ cmenvaud/339/33905.htm

6. The Green Alliance (PKG0026B) cited in: House of Commons, ‘Plastic bottles: Turning Back the Plastic Tide’ available from: publications.parliament. uk/pa/cm201719/cmselect/ cmenvaud/339/33905.htm

7. Explore the facts (2019) One Less Bottle, available from; onelessbottle.org/explore-thefacts/

8. Bottled Water (2017) Ethical Consumer, available from; ethicalconsumer.org/food-drink/ shopping-guide/bottled-water

9. Drinking Water Inspectorate (2017) available from; dwi.defra. gov.uk/about/what-we-do/index. htm

10. Younger, P.L.(2012) Water. All That Matters. Hodder Education: London UK.

11. Thames water (2016) Is there fluoride in my water and is it added by Thames Water? Available from; thameswater.co.uk/help-andadvice/water-quality/whats-inyour-water/other-questions

12. The Water Supply Regulations (1999) available from; legislation. gov.uk/uksi/1999/1148/ regulation/5/made

13. Millions of Brits would ditch bottled water if tap water was more freely available (2017) available from; yougov.co.uk/ news/2017/05/19/millions-britswould-ditch-bottled-water-iftap-wa/

14. A Green Future: Our 25 Year Plan to Improve the Environment (2018) p88 available from; gov. uk/government/uploads/system/ uploads/attachment_data/ file/673203/25-year-environmentplan.pdf

15. Understanding provision, usage and perceptions of free drinking water to the public in the UK (2017) p4 available from; keepbritaintidy. org/sites/default/files/resources/ KBT_CFSI_BRITA_Water_Water_ Everywhere_2017.pdf

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