Intended for healthcare professionals

Observations Yankee Doodling

Bottled water for all, all the time?

BMJ 2016; 352 doi: (Published 01 March 2016) Cite this as: BMJ 2016;352:i1214
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, Washington, DC, professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

Doctors should follow some US cities in discouraging bottled water consumption

Current US headlines about unsafe municipal drinking water in Flint, Michigan, and elsewhere are likely to scare even more people away from drinking good old tap water.1 These rare cases, where it is actually appropriate to reach for bottled water, may lead to widespread increases in consumption of bottled water. That is bad news.

Here in Washington, DC, everyone seems to be drinking bottled water all the time. People bring water with them to meetings (coffee is out of favor). They carry it when they walk around. They have it with them in the gym, of course. And now it is even allowed (and encouraged, by sales) at theaters and cinemas. It infuriates me.

When asked why they chug water, people say to “remain hydrated,” as if they were going across the desert instead of across the office suite. Often they will cite the folk wisdom (well debunked2 3) that humans need to drink eight glasses of water a day to maintain health.

If this were just tap water in a refillable bottle I wouldn’t really care. More often than not, though, the water comes in a “recyclable” plastic bottle sporting a fancy label and a foreign pedigree. Water from New England springs. Water filtered through volcanic rock in Fiji. Water with added vitamins. There is, of course, no evidence that such water is better for you, though it may taste different.

Not all bottled water comes from exotic locales or with additives. Coca-Cola and Pepsi’s US water brands, Dasani and Aquafina, respectively, are actually sourced from municipal water supplies.4 It must be the extra filtration that makes them worth the premium price. And you don’t have to pay a lot for bottled water, either. All the discount stores sell gigantic plastic wrapped water bundles for as little as 18 cents (£0.13; €0.16) a bottle. (That is only about 15 times what it costs to produce; I guess that’s a bargain.)

But let’s leave aside the bogus health claims and focus on the plastic bottles for the real source of the problem.

Americans use about 50 billion plastic water bottles a year. That’s more than 150 bottles for each adult and child living here. This seems like a bit more than we need, especially when we consider that only 20-30% of the bottles are actually recycled, leaving billions of bottles to be discarded as trash. More than two million tons of plastic water bottles end up in US landfills. Not a pretty sight.4 5

Then there is the energy and, yes, water needed to manufacture, fill, ship, and deliver 50 billion plastic water bottles. Energy estimates range up to 17 million barrels of oil a year, enough to run over a million cars for a year. The amount of water needed in this entire process dwarfs the amount of water actually in the bottles themselves. It takes from 3 L to 26 L of water for each liter bottle, depending on whether the bottle comes from the US or Fiji.4 5

Some US cities and our national parks are beginning to outlaw sales of bottled water. That is a good sign. Maybe it is time for doctors, and not just public health doctors, to get into the act and remind their patients that water from the tap is fine to drink and better for the world than lugging around disposable plastic bottles filled with filtered, purified, flavored, imported, vitaminized—water?



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