The world health organization recommends against the use of artificial sweeteners for weight management

Consumption of sugar has been associated with escalating rates of overweight and obesity, dental caries, Type 2 diabetes, cardiovascular and cancers. The WHO and the EAT Lancet recommend cutting free sugar intake to no more than 5% of daily energy intake for maximum health benefits. For the average person this amounts to about 27 g of sugar or 6 teaspoons per day. Just one 600 ml bottle of soft drink or 1 slice of commercial chocolate cake contains over 64 grams or 16 teaspoons of added sugar. It is easy to understand why many Australian’s are exceeding the recommended sugar intake, and it is not surprising that there has been a concerted effort to look for ways to reduce sugar consumption.

Non nutritive sweeteners (NNS) are artificial sweeteners or natural sweeteners that taste sweet but contain no or little calories. Examples include aspartame, monk fruit extract, saccharin, sucralose, stevia, acesulfame potassium (ace-K), and cyclamate. However, the World Health Organization released guidelines in 2023 on the use of non nutritive sweeteners (NNS) and advises against their use to reduce the risk of unhealthy weight gain or to prevent non-communicable diseases such as Type 2 diabetes.

The WHO conducted a systematic review and meta-analysis on the health effects of non nutritive sweeteners and looked at overweight and obesity, Type 2 diabetes, all cause mortality, cardiovascular disease, chronic kidney disease, cancer, eating behavior, sweet preference, dental caries, mood, nuerocognition and behavior.

There was a reduction in body weight in randomized controlled trials (RCT’s) and a reduction in energy intake when sugar was replaced with NNS. But for body mass index (BMI), the results were not statically significant. Furthermore, if NNS replaced water, there was also no change in body weight. Observational data suggests that NNS is associated with elevated BMI. In terms of non-communicable disease there was an elevated risk of cardiovascular disease (stroke and hypertension), Type 2 diabetes and all cause mortality but no elevated risk for other non-communicable diseases.

The conclusion of the review was that the potential benefits of using NNS only seems apparent in people replacing usual sugar intake with NNS and not for people that don’t habitually use sugar. Therefore using NNS in place of sugar may expose people to the risks of NNS unnecessarily.

NNS are found in soft drinks, yogurts, coffee, canned fruit, confectionery, other beverages and formula products. About 18.5% of adults and 8.2% of children use artificial sweeteners per day in Australia (Grech, 2018) .The best beverages to drink include water, tea or coffee, that are all naturally sugar free and maybe able to become accustomed to the flavor without the use of sugar or NNS. Use honey or fresh fruit to sweeten natural yogurt and avoid soft drinks and eating confectionery and other products with sugar added to them. For a bit of sweetness, select fresh fruit that has dietary fiber and other micro-nutrients that are good for your health.

See an accredited practicing dietitian for advice on reducing your sugar intake.

References

Use of non-sugar sweeteners: WHO guideline. Geneva: World Health Organization; 20 Licence: CC BY-NC-SA 3.0 IGO.

Processed foods the cause of the rise in obesity

Over the past few decades the world has witnessed unrelenting increases in the prevalence of overweight and obesity. As many as 2 in 3 Australian’s battle to keep their weight in check. A surprising fact is that not a single country has managed to stop the rise in the prevalence of overweight and obesity.

In our research of 9.400 Australian adults, we learned that obesity is set to continue to rise for much of the population. At the heart of the problem is low protein, highly processed foods or ‘discretionary foods’. These include foods such as frozen ready meals, cakes, biscuits, commercial pizzas and burgers, sausages and other processed meats, ice creams, chocolates. soft drinks and other packaged and highly processed foods.

The protein leverage hypothesis first proposed by David Raubenheimer and Stephen Simpson, offers an explanation as to why these foods are contributing to rise in obesity. We eat to a protein target each day and because of this, when the proportion of protein in the diet decreases, we need to over consume carbohydrate and fats to reach our protein target for the day. Many of the foods available today in our supermarkets, restaurants and our pantry with highly processed foods that are dilute in protein making up but make up as much as 40% of our daily energy intakes.

In addition to manufactured foods being low in protein to be low in protein, climate change may be exacerbating the problem because the carbohydrate and sugar concentrations of fruits and grains are increasing relative to the amount of protein. Alcohol is one example of where this has been happening and the sugar concentration of grapes has been increasing, elevating the alcohol and therefore energy content per millimeter of wine.

While we can’t change our the global food environment, we can change our home food environments. The easiest way to do this is to stock your pantry with fresh, minimally processed ingredients such as fresh fruits and vegetables, lean meat, fish, seafood, nuts, legumes and high quality whole-grains and avoid ultra-processed products. If you are managing your weight it is advisable to avoid all foods high sugar, fat and excess alcohol.

The National Health and Medical Research Center recommends that Australians consume between 15-25% of their energy from protein to manage their energy intakes. An Accredited Practicing Dietitian can help achieve this.

References:

Grech A, Sui Z, Rangan A, Simpson SJ, Coogan SCP, Raubenheimer D. Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis. Obesity. 2022;30(11):2156-66. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23578

Raubenheimer, D & Simpson, S. “Eat Like the Animals, What Nature Teaches Us about the Science of Healthy Eating” . HarperCollins Publishers (Australia) Pty Ltd