The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial

Abstract

Objective: To evaluate the effects of water versus beverages sweetened with non-nutritive sweeteners (NNS) on body weight in subjects enrolled in a year-long behavioral weight loss treatment program.

Methods: The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight-stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year.

Results: NNS and water treatments were non-equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference).

Conclusions: Water and NNS beverages were not equivalent for weight loss and maintenance during a 1-year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.

Figure 1

Consort diagram. Screening, enrollment, randomization, and follow‐up of study participants.

Figure 2

(a) Fitted model for group mean percent body weight change over time using a polynomial mixed effects model, which was fit to the weekly weight data expressed as percent change from the individual baseline weight, and an intention‐to‐treat analysis. Errors bars represent the standard error of the mean. P < 0.001 for between‐group comparisons at all time points. (b) Fitted model for group mean percent body weight regained from point of maximum weight loss using an intention‐to‐treat analysis. P < 0.001 for difference in velocity of weight regain between groups.

Figure 3

Percentage of participants who achieved at least 5% weight loss. Results based on χ ² analysis. Analysis includes those participants who dropped out of the study, using the baseline observation carried forward. This analysis mimics the clinical setting. Difference = 0.1865 or 18.65% difference between groups with 90% CI (0.1065‐0.2735), n = 154 for NNS, n = 149 for water. *P < 0.001.