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Rudisill, Melinda FND430- Annoted Bibliography
Artificial Sweeteners as MNT for weight loss and management
Introduction
Artificial sweeteners are commonly available and consumed in the belief that they assist with weight
loss or maintenance of healthy body weight. However, the use of artificial sweeteners remains divisive
because of data indicating a positive correlation between artificial sweetener use and weight gain, and
possible risks associated with their long term use. Furthermore, as scientists retrospectively analyze data
collected since their introduction, the widespread use of artificial sweeteners has correlated with the
increased incidence of overweight and obesity. 3 Scientific literature was critically analyzed for
information regarding the use of artificial sweeteners as MNT for weight loss and long-term weight
management. Four literature reviews, one academy of nutrition and dietetics position paper, ten
scientific investigations, and one interview were reviewed. Clinical trials on humans and epidemiologic
studies were selected. The majority of long term studies performed are epidemiologic and use data
collected from other research studies for their investigations. Studies are typically limited by a female
gender bias. Conclusions support the current Academy of Nutrition and Dietetics position that artificial
sweeteners may contribute to enhanced weight loss and maintenance as a part of a comprehensive diet
program. MNT for weight loss and management should focus on decreasing overall energy intake and
increasing physical activity according to 2010 Dietary Guidelines for Americans.1 Artificial sweeteners
may assist some individuals in limiting energy intake by allowing them to consume non-nutritive
substitutes for sugar-sweetened foods and vegetables.
Rudisill, Melinda FND430- Annoted Bibliography
Annotated Bibliography
Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive sweeteners. J Acad
Nutr Diet. 2012; 112: 739-758.
Key recommendation in DGA related to NNS is to control total energy intake and increase
physical activity to manage body weight. Eating patterns that are low in energy density promote
weight loss and maintenance. National Cancer institute in 2009 noted there was no clear
evidence linking NNS use and cancer risk in humans. Grade I Conclusion statements indicate that
use of aspartame and aspartame sweetened products as part of a comprehensive weight loss or
maintenance program by individuals may be associated with greater weight loss and assist
individuals with weight maintenance over time, and good evidence that aspartame use does not
affect appetite or food intake in adults.
Benton D. Can artificial sweeteners help control body weight and prevent obesity? Nutr Res Rev. 2005;
18: 63-76.
This article reviews several studies investigating the long term effects of consuming artificial
sweeteners. Benton critics that current research does not support the hypothesis that the longterm use of artificial sweeteners helps to prevent weight gain. The article presents several
studies indicating that dietary fat is the macronutrient of interest in weight management.
Evidence supports that those in acceptable weight ranges compensate for decreased energy
intake when using artificial sweeteners, essentially negating the sweetener’s usefulness in
limiting caloric intake.
Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings. Yale J
Biol Med. 2010; 83:101-108
This article reviews several large scale prospective cohort studies that found a connection
between the use of artificial sweeteners and weight gain. Overall, the weight gains were small
Rudisill, Melinda FND430- Annoted Bibliography
when compared to control groups, but after analysis the researchers concluded they were
statistically significant. Author reviews studies that explore how sweetness perception
separated from energy intake offers only a partial activation of food reward pathways. As a
result, subjects overeat to achieve full pleasure reward associated with eating. Several
interventional studies conclude that artificial sweetener use does not reduce weight when used
separate from interventions such as calorie restriction and exercise.
Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: Different
effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight
subjects. Am J Clin Nutr. 2002; 76:721-729.
This paper describes a study where the participant’s diets were supplemented with either
sucrose sweetened or artificially sweetened beverages and foods. Study results were not able
to confirm that non-energetic sweeteners can increase appetite through stimulation of the brain
and taste receptors. Weight loss in the artificial sweetener group was explained by the decrease
in overall energy consumption. This decrease was achieved by the replacement of higher energy
foods and drinks with the lower- energy sweetener supplements. Participants in this study were
obese. Study is relevant because it indicates that overweight individuals may be able to
substitute artificial sweeteners for sucrose in foods to successfully manage weight and prevent
weight gain.
Piernas C, Tate DF, Wang X, Popkin B. Does diet-beverage intake affect to dietary consumption patterns?
Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized trial. Am J
Clin Nutr. 2013; 97:604-11.
Participants in this study replaced caloric beverages with either water or diet soda. Both
experimental groups reduced consumption of protein and carbohydrates over time. Initially, the
diet beverage group increased consumption of fats; however, they later decreased consumption
Rudisill, Melinda FND430- Annoted Bibliography
by percentages comparable to the water group at month 6. Both groups decreased energy
intakes and improved dietary habits overtime. Noteworthy, is that the diet beverage group
decreased more calories from caloric beverages and desserts than the water group. This is
important because the study results do not support the hypothesis that consumption of
artificially sweetened beverages increases preferences for sweet foods and beverages, at least
in the short term.
Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic?
Artificial sweetened beverage use and long-term weight gain. Obesity J. 2008; 16: 1894-1900.
Study investigated effects of artificially sweetened (AS) beverage consumption on long-term
weight change by comparing participants in the San Antonio Heart study. Researchers found a
positive dose-response relationship between AS beverage consumption and long term weight
gain. Results indicate that AS beverage consumption may be directly or indirectly related to
weight gain. Relevant source because study spanned 8 years and provides longer-term data on
AS beverage consumption and weight change.
Malik V, Schulze MB, Hu FB. Intake of sugar sweetened beverages and weight gain: a systematic review.
Am J Clin Nutr. 2006; 8:274-288.
Review examined thirty publications of cross-sectional, prospective, and experimental studies
relating sugar sweetened beverage (SSB) intake and risk of weight gain. Authors concluded that
the weight of experimental and epidemiologic evidence supports a positive relation between
SSB consumption and weight gain. Artificially sweetened beverages could provide an alternative
to SSBs and discourage consumption of sugary drinks that leads to weigh gain, thereby helping
clients better maintain weight and weight loss.
Rudisill, Melinda FND430- Annoted Bibliography
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willet WC, Hu FB. Sugar sweetened
beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.
JAMA. 2004; 292(8): 927-934.
Study found that frequent consumption of sugar sweetened may be associated with weight
gain. Researchers suggest Public Health strategies to prevent obesity should be focused on
reducing sugar-sweetened beverage consumption. Artificially sweetened beverages are an
alternative choice that may prevent weight gain associated with sugar sweetened beverages.
Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food
intake and their putative mechanisms. Am J Clin Nutr. 2009; 89:1-14.
Several studies have concluded that the addition of nonnutritive sweetener (NNS) to food
products providing little to no energy heightens appetite as opposed to consuming that food
product independently. However, one study of similar structure replicated results using sodium
chloride in soup, indicating that NNS may not be solely responsible for this effect. No appetite
alteration is observed when NNS is consumed in food products providing energy. Research
indicates that energy restriction is the essential element of MNT for weight loss and
management. There is a lack of evidence supporting that the use of NNS in free living individuals
results in improved weight loss or maintenance. Conversely, there is also a lack of evidence
supporting the proposed mechanisms by which NNS may increase caloric intake and contribute
to weight gain. Source is valuable in that it reviews several studies and indicates that NNS should
not be the primary intervention in MNT for weight loss and management. It presents NNS as
neither helpful nor harmful.
Phelan S, Lang W, Jordan D, Wing RR. Use of artificial sweeteners and fat-modified foods in weight loss
maintainers and always-normal weight individuals. Int J Obes (Lon). 2009; 33:1193-1190.
Rudisill, Melinda FND430- Annoted Bibliography
Study results revealed that weight loss maintainers use more artificial sweeteners and fatmodified foods to accomplish weight maintenance than individuals who have always been
classified as normal weight. Artificially sweetened products may be useful for clients wishing to
restrict calorie intake and maintain normal weight ranges without restricting consumption of
foods and beverages traditionally sweetened with sugar.
Shankar P, Ahuja S, Sriram K. Non-nutritive sweeteners: Review and Update. Nutrition. 2013; 29: 12931299.
Article is a systematic review of several databases and websites to identify literature related
non-nutritive sweeteners (NNS). It is a valuable resource because it analyzes multiple sources.
Of the studies reviewed, there is a lack of evidence based research indicating a strong
correlation between NNS use and weight loss or maintenance. Because the data is inconclusive
recommendations are made for sweeteners, both nutritive and nonnutritive, to be used in
moderation. Importance of calorie restriction is once again upheld. Review agrees with the
position of the Academy and emphasizes that weight management depends more on total
calorie restriction rather than avoidance of caloric sweeteners.
Blackburn GL, Kanders BS, Lavin PT, Keler SD, Whatley J. The effect of aspartame as part of a
multidisciplinary weight-control program on short- and long-term control of body weight. Am J
Clin Nutr. 1997; 65(2): 409-418.
Study randomly assigned obese woman to consume or abstain from aspartame during 16 weeks
of a 19 week weight loss program. Study data suggests that addition of aspartame to a weightcontrol program that addresses diet, exercise, and psychosocial elements of health and nutrition
may improve long-term maintenance of lost body weight. Study is limited by gender bias and
short term follow up period.
Rudisill, Melinda FND430- Annoted Bibliography
Rodin J. Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and
macronutrient intake. Am J Clin Nutr. 1990; 51: 428-435.
Subjects were given water, aspartame, glucose, or fructose preloads before meals in a
randomized fashion. The aspartame and plain water preloads resulted in similar amounts of
food consumed at meal time. Paper contradicts theory that artificial sweetener consumption
may lead to increased appetite and intake, followed by subsequent weight gain.
Anton SD, Martin CK, Han H, Coulon S, Cefalu WT, Geiselman P, Williamson DA. Effects of stevia,
aspartame, and sucrose on food intake, satiety and postprandial glucose and insulin levels.
Appetite. 2010; 55: 37-43.
Study was performed over three separate days. Each day participants consumed preloads
before their lunch and dinner meals and then monitored for their mealtime consumption.
Preloads contained stevia, aspartame, and sucrose. Participants did not compensate by eating
more at mealtime when they consumed the stevia or aspartame preload as compared to
sucrose, and reported similar levels of satiety after the meal was completed. Study is limited by
short time frame where subjects may not have been given adequate time to allow for dietary
compensation. It may not adequately reflect effects of NNS use over time.
Cantley LC. Cancer, metabolism, fructose, artificial sweeteners, and going cold turkey on sugar. BioMed
Central. 2014; 12:8.
This is an interview with a distinguished researcher and current director of the new Cancer
Center at Weill Cornell Medical College and New York- Presbyterian Hospital. The interviewee
discusses how artificial sweeteners cause a discrepancy in the brain between sweetness tasted
and amount of glucose consumed. Addiction to sweetness is increased and dietary
compensation follows. Source coincides with other sources supporting theory that artificial
Rudisill, Melinda FND430- Annoted Bibliography
sweeteners may not be and effective solution for long term weight management because they
encourage sugar craving and addiction.
Whitehouse Cr, Boullata J, McCauley LA. The potential toxicity of artificial sweeteners. Workplace Health
Saf. 2008; 56(6): 251-259.
Source is an article written by nurses to educate healthcare professionals on how to advise
clients regarding the use of artificial sweeteners. Research is inconclusive regarding risks of
artificial sweetener use and occupational nurses are advised to educate clients regarding
potential risks and benefits of artificial sweetener use. More importantly, nurses are encouraged
to promote exercise and healthy eating habits to clients. Source supports the hypothesis that
artificial sweeteners should not be used alone as MNT for weight loss and management, but
may be beneficial to some clients in conjunction with other interventions.