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THE EFFECTS OF WATER AND NON-NUTRITIVE SWEETENED BEVERAGES ON
WEIGHT LOSS DURING A 12-WEEK WEIGHTLOSS TREATMENT PROGRAM
Danielle Ostendorf, M.S.Ph.D candidate, Epidemiology, Colorado School of Public Health
Research Assistant, Anschutz Health and Wellness CenterUniversity of Colorado Denver303-724-8345; [email protected]
mailto:[email protected]:[email protected] -
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CONFLICT OF INTERESTS
This study was fully funded by the American BeverageAssociation
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INTRODUCTION
What are Non-Nutritive Sweeteners(NNS)?
Observational studies report a positiveassociation between NNS and weight gain
- But, what about reverse causality?
What does previous experimentalresearch say?
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Role of Non-Nutritive Sweeteners (NNS) inweight loss is controversial
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OUR GOAL
To assess, in a randomized clinical trial, whether NNSbeverages versus water produce equivalent weight lossamong people in a behavioral weight loss program
= ?Weight
Loss
Weight
Loss
+ +
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METHODS
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Figure 1: Screening, enrollment,randomization, and follow-up ofstudy participants
Study Dropouts:5.8% for NNS10% for Water
Similar baseline characteristics betweengroups including:
- Age, Gender, Race, Ethnicity,Weight, BMI, Blood Pressure
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STUDY DESIGN
1 year equivalence randomized clinical trial
- 12 week weight loss phase and a 9 month weight
maintenance phase
Subjects were recruited from a population of overweightand obese men and women (BMI 27-40) who reportedconsuming NNS beverages at least 3 days of the week.
Random assignment to NNS or water treatment
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INTERVENTION
Colorado Weigh
- 12 weekly, 60 minute group sessions led by
dieticians or clinical psychologists- Individual energy targets: RMR rounded to nearest100 kcal
- Physical activity: end goal of 60 min/day, 6days/week
NNS: 24 ounces per day; water consumption notrestricted
Water: 24 ounces of water per day; not allowed to haveNNS beverage
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RESULTS
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Metabolic and hunger changes from baseline to week 12 in theNNS and water groups
All analyses are from mixed effect models. Statistically significant values (p < 0.05) are shown by an asterisk (*) and statistically significant p values are shown in bold.NNS, Non-nutritive sweetener group; water, water group; PA, Physical Activity. For Cholesterol: n = 142 for NNS and n = 133 for water. For LDL: n = 140 for NNS and131 for water. For How hungry did you feel over the past week: n = 136 for NNS and n = 125 for water. For Total Moderate PA : n = 136 for NNS and n = 126 for water.All values are means; Standard Error in parentheses.
Assessment PeriodOutcome Variable and Group Baseline Week 12 Change P value for
ChangeCholesterol (mg/dL)NNS 190.68 (2.76) 173.92 (2.70) -16.76 (1.99) *
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Absolute Weight Loss (lbs) from baseline to week 12:
Intent to Treat Analysis
207
193.9
205.4
196.3
190
195
200
205
210
Baseline Week 12
W
eight(lbs)
NNS
Water
*p Value for Difference in Absolute Weight Loss: p < 0.0001
*
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Absolute Weight Loss (lbs) from baseline to week 12:Completers Analysis
206.3
192
207
196.9
185
190
195
200
205
210
Baseline Week 12
Weight(lbs)
NNS
Water*
*p Value for Difference in Absolute Weight Loss: p < 0.0001
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Percent participants who achieved at least 5% weight loss1
1Results based on Chi-square analysis. Analysis includes those participants who dropped out of the study, using the baseline
observation carried forward. Difference = 0.2133 or 21.33% difference between groups with 09% CI (0.12120.3054). N = 154 for
NNS, n = 149 for Water.
p = 0.0002
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So why did the NNS group have greater weight loss?
We are unable to determine the underlyingmechanism
What about differences in:
- Hunger?
- Physical Activity?
- Cholesterol?- Adherence to calorie goals?
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CONCLUSIONS Despite findings from previous observational research,
our results provide support for use of NNS beverages incontext of behavioral weight loss program
NNS drinkers can continue to drink NNS beverages
without concern that weight loss efforts will beundermined
Similar to Tate et al. (2012), NNS beverages do not hinderweight loss.
- Follow up study showing no evidence that a short-
term consumption of diet beverages increasespreferences for sweet foods and beverages
Results are consistent with evidence from the NationalWeight Control Registry (Phelan et al., 2009)
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SIGNIFICANCE AND STRENGTHS
This is the first randomized clinical trial to compare waterand NNS in the context of a controlled weight loss program
Valid outcome data- Weight
- Cholesterol, LDL, glucose
- Blood pressure
- Objective physical activity monitors
Multisite study (PA and CO)
- Large, diverse sample size (303 participants)
- Sufficient power to detect a difference
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FUTURE DIRECTIONS
Long term follow-up of this study (weight loss maintenancephase) is underway
Do NNS beverages affect food intake and food selection? For people who dont normally consume NNS beverages,
what is the effect of NNS on weight loss?
Are there differences in weight loss based on type of non-
nutritive sweetener?
- Aspartame (NutraSweet and Equal)- Stevia
- Sucralose (Stevia)
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ACKNOWLEDGEMENTS
Special Thanks to:
Investigators:
- Dr. Peters, Dr. Wyatt, Gary Foster, Zhaoxing Pan,Alexis Wojtanowski, Stephanie Vander Veur, Sharon
Herring, Carrie Brill, and Dr. Hill
Colorado Study Team
Temple University Study Team
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QUESTIONS?
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CONTACT INFORMATION
Link to Study Manuscript:http://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdf
Dr. John Peters, Study PI: [email protected]
Carrie Brill, Clinical Programs Manager:[email protected]
Danielle Ostendorf, Research Assistant:[email protected]
http://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdfmailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdfhttp://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdf