THE EFFECTS OF WATER AND NON-

NUTRITIVE SWEETENED BEVERAGES ON

WEIGHT LOSS DURING A 12-WEEK WEIGHT
LOSS TREATMENT PROGRAM
Danielle Ostendorf, M.S.
Ph.D candidate, Epidemiology, Colorado School of Public Health
Research Assistant, Anschutz Health and Wellness Center
University of Colorado Denver
303-724-8345; Danielle.Ostendorf@ucdenver.edu
2
CONFLICT OF INTERESTS
This study was fully funded by the American Beverage
Association



3
4
INTRODUCTION
What are Non-Nutritive Sweeteners
(NNS)?

Observational studies report a positive
association between NNS and weight gain
- But, what about reverse causality?

What does previous experimental
research say?

5
Role of Non-Nutritive Sweeteners (NNS) in
weight loss is controversial

6
OUR GOAL

To assess, in a randomized clinical trial, whether NNS
beverages versus water produce equivalent weight loss
among people in a behavioral weight loss program

=
?
Weight
Loss
Weight
Loss
+
+
METHODS
8
Figure 1: Screening, enrollment,
randomization, and follow-up of
study participants
Study Dropouts:
5.8% for NNS
10% for Water
Similar baseline characteristics between
groups including:
- Age, Gender, Race, Ethnicity,
Weight, BMI, Blood Pressure
9
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 overweight
and obese men and women (BMI 27-40) who reported
consuming NNS beverages at least 3 days of the week.

Random assignment to NNS or water treatment

10
INTERVENTION
Colorado Weigh
- 12 weekly, 60 minute group sessions led by
dieticians or clinical psychologists
- Individual energy targets: RMR rounded to nearest
100 kcal
- Physical activity: end goal of 60 min/day, 6
days/week
NNS: 24 ounces per day; water consumption not
restricted
Water: 24 ounces of water per day; not allowed to have
NNS beverage

RESULTS
12
Metabolic and hunger changes from baseline to week 12 in the
NNS 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 and
131 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 Period
Outcome Variable and Group Baseline Week 12 Change P value for
Change
Cholesterol (mg/dL)
NNS 190.68 (2.76) 173.92 (2.70) -16.76 (1.99) * <0.0001
Water 193.23 (2.80) 184.38 (2.77) -8.86 (2.05) * <0.0001
NNS Water -2.56 (3.93) -10.46 (3.87) * -7.90 (2.86) * 0.0061
LDL (mg/dL)
NNS 114.92 (2.42) 103.39 (2.34) -11.53 (1.72) * < 0.0001
Water 116.44 (2.45) 110.77 (2.39) -5.68 (1.77) * 0.0015
NNS Water -1.52 (3.44) -7.38 (3.34) * -5.86 (2.47) * 0.0184
How hungry did you feel over
the past week (scale 1
100)?

NNS 51.91 (1.57) 48.42 (1.47) -3.49 (1.92) 0.0694
Water 47.93 (1.62) 51.34 (1.53) 3.41 (1.99) 0.0877
NNS - Water 3.98 (2.25) -2.92 (2.12) -6.90 (2.76) * 0.0130
13
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
e
i
g
h
t

(
l
b
s
)

NNS
Water
*p Value for Difference in Absolute Weight Loss: p < 0.0001
*
14
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
W
e
i
g
h
t

(
l
b
s
)

NNS
Water
*
*p Value for Difference in Absolute Weight Loss: p < 0.0001
15
Percent participants who achieved at least 5% weight loss
1
1
Results 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 (0.1212 0.3054). N = 154 for
NNS, n = 149 for Water.
p = 0.0002
16
So why did the NNS group have greater weight loss?

We are unable to determine the underlying
mechanism

What about differences in:
- Hunger?
- Physical Activity?
- Cholesterol?
- Adherence to calorie goals?


17
CONCLUSIONS
Despite findings from previous observational research,
our results provide support for use of NNS beverages in
context of behavioral weight loss program
NNS drinkers can continue to drink NNS beverages
without concern that weight loss efforts will be
undermined

Similar to Tate et al. (2012), NNS beverages do not hinder
weight loss.
- Follow up study showing no evidence that a short-
term consumption of diet beverages increases
preferences for sweet foods and beverages

Results are consistent with evidence from the National
Weight Control Registry (Phelan et al., 2009)

18
SIGNIFICANCE AND STRENGTHS
This is the first randomized clinical trial to compare water
and 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
19
FUTURE DIRECTIONS
Long term follow-up of this study (weight loss maintenance
phase) 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)
20
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
21
QUESTIONS?
22
CONTACT INFORMATION
Link to Study Manuscript:
http://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdf

Dr. John Peters, Study PI: John.Peters@ucdenver.edu

Carrie Brill, Clinical Programs Manager:
Carrie.Brill@ucdenver.edu

Danielle Ostendorf, Research Assistant:
Danielle.Ostendorf@ucdenver.edu