A recent randomized trial suggests that incorporating sugar-substitute sweeteners and sweetness enhancers into a sugar-reduced maintenance diet post-weight loss can lead to improved weight maintenance and well-being among adults, without increasing the risk of type 2 diabetes or cardiovascular disease. Additionally, among overweight or obese children, greater reductions in uncontrolled eating were observed among those receiving the sweeteners.
This study challenges previous reports that raised concerns about the use of non-sugar sweeteners, including recent research suggesting no benefits in weight control and a potential increase in the risk of type 2 diabetes or cardiovascular disease associated with these sweeteners.
Methodology:
The findings stem from an exploratory analysis of the multicenter, randomized SWEET trial involving 341 adults with overweight or obesity (aged 18-65 years) and 38 overweight children (aged 6-12 years). Participants were recruited from Denmark, Spain, Greece, and the Netherlands through various channels, including webpages, social media, newspapers, and registries.
During the initial two months of the trial, adults followed a low-energy diet (the Cambridge Weight Plan) aiming for at least 5% weight loss, while children received dietary advice to maintain body weight. Subsequently, participants were randomized to healthy diets with less than 10% of calories from added sugar, allowing foods and drinks with sweeteners and sweetness enhancers, or the same diet without these additives.
Participants’ weight, body mass index (BMI), anthropometry, and risk markers for type 2 diabetes and cardiovascular disease were monitored at baseline and at 2, 6, and 12 months. Additionally, food frequency questionnaires and urine samples were collected to assess compliance with dietary instructions.
Key Findings:
Both sweetener and non-sweetener groups showed decreased consumption of high-sugar products, but the reduction was significantly higher in the sweetener group.
In the intention-to-treat analyses, adults permitted sweeteners experienced slightly greater weight loss maintenance after one year compared to the non-sweetener group.
There were no differences between the groups in markers for type 2 diabetes and cardiovascular disease among participants who completed the trial.
Adults in the sweetener group reported greater diet satisfaction when eating out, increased positive mood, and reduced craving for sweet food compared to the non-sweetener group.
Among children with higher uncontrolled eating scores at baseline, those allowed sugar-substitute sweeteners showed significantly lower uncontrolled eating scores at 12 months compared to the non-sweetener group.
Implications:
Co-lead author Clarissa Dakin of the University of Leeds, England, noted that the findings suggest potential benefits of including low/no energy-sweetened products, especially for children with high levels of uncontrolled eating. She emphasized the significance of these insights for ongoing evaluations of food additive sweeteners by regulatory agencies.
Co-author Jason Halford, also from the University of Leeds, highlighted the evolving understanding regarding the use of low-calorie sweeteners in weight management, refuting concerns raised by observational studies linking their use to weight gain.
In conclusion, the study provides valuable insights into the role of sweeteners in weight maintenance and eating behavior, challenging previous assumptions and underscoring the need for continued research and regulatory scrutiny in this area.