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Non-nutritive sweetened beverages do not undermine weight-loss efforts
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Individuals who consume non-nutritive sweetened beverages can continue to drink them as part of a comprehensive behavioral weight-loss program and still shed pounds — potentially more than they would by switching to water, according to research published in the June issue of Obesity.
During a 12-week weight-loss phase of a 1-year prospective randomized trial conducted by John C. Peters, PhD, of Anschutz Health and Wellness Center at University of Colorado in Aurora, and colleagues, 279 participants (80% female, aged 21 to 65 years) lost significant weight with both water and non-nutritive sweetened (NNS) beverages — but more with the latter.
John C. Peters
“Water is still the gold standard,” Peters told Endocrine Today. “We do not recommend people give up water for diet soda. These results provide some reassurance that diet drinks can be a useful tool in body weight management.”
The participants, from the University of Colorado and Temple University in Philadelphia, had BMI ranging from 27 kg/m2 to 40 kg/m2 and were eligible if they had remained weight-stable within 10 lb in the previous 6 months; they all engaged in fewer than 300 minutes of physical activity and consumed at least three NNS beverages per week.
Individuals in the NNS beverage group (n=145) were asked to consume 24 fluid oz per day (<5 kcal per 8-oz serving, pre-mixed, contained non-nutritive sweeteners.) and were not limited in their water consumption. Those in the water group (n=134) were asked to consume 24 oz each day and no NNS beverages at all; they could eat foods containing non-nutritive sweeteners but could not add it to drinks intentionally.
The notion that “diet sodas interfere with weight loss, as has often been touted in the popular media,” comes from observational studies that associate higher body weight with higher diet soda consumption, Peters said. But, he added, it is not possible to determine cause and effect from such studies.
At 12 weeks, the NNS beverage treatment group lost significantly more weight compared with the water group (5.5 kg vs. 3.8 kg; P<.0001). With NNS, 64.3% of participants lost >5% of their body weight vs. 43% of those drinking water (P=.0002). No significant differences were witnessed in waist circumference, glucose, systolic blood pressure, HDL and triglycerides; reductions in total cholesterol and LDL were significantly greater in the NNS group. Participants in the NNS group also reported significantly greater reductions in subjective feelings of hunger compared with those in the water group.
“Bottom line,” Peters said, “if you are a diet soda drinker and are worried based on what you read that they may interfere with weight loss, or even drive weight gain, don’t worry.”
The remaining 9 months of the trial will look at weight maintenance after the weight loss with the same treatment, which the researchers expect to report later this year.
In an accompanying editorial, Stephen D. Anton, PhD, of the University of Florida in Gainesville, said the findings provide an important contribution but should be “interpreted with caution since longer-term outcomes are needed to confirm these results and the potential mechanisms for the superior effects of NNS on weight loss outcomes observed in this study is currently unknown.” – by Allegra Tiver
For more information:
Anton SD. Obesity. 2014;doi:10.1002/oby.20779.
Peters JC. Obesity. 2014;doi:10.1002/oby.20737.
Disclosure: The Peters study was fully funded by The American Beverage Association. Two of the researchers received consulting fees from The Coca-Cola Company outside of this work.
Perspective
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Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU
This study adds to a balanced discussion of the use of non-nutritive sweeteners (NNS) in the management of overweight/obesity and demonstrates that in people who have already been consuming NNS in their diet, further consumption of NNS compared with water is associated with superior effects on weight loss.
However, this study has limitations: Confounding effects of prior NNS use; lack of precise control over type of NNS used in beverages and other foods; use of NNS in non-beverages (both groups); precise eating patterns in both groups; precise energy expenditures in both groups; and a relatively short study duration of 12 weeks.
Translating these associative relationships showing a benefit with NNS beverages into causality will be difficult due to complex physiological mechanisms of NNS on intestinal taste receptors and activation of various incretin, hormonal, endocrine disruption, and microbiome effects.
Nevertheless, as previously stated, this adds to a balanced evidence base on the matter. Further research is needed and, at present, the routine use of NNS beverages as part of an obesity management plan that targets decreased caloric consumption, cannot be supported because there is still insufficient evidence that NNS intrinsically causes weight loss beyond caloric restrictions.
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