Researchers investigated whether artificial sweeteners are linked to an unhealthy lifestyle in those who are morbidly obese.

With the prevalence rates of overweight and obesity in adults worldwide escalating over the last 30 years, the obesity epidemic has become one of the world’s largest public health concerns. Those who are defined as overweight or obese according to their body mass index (BMI) have an increased risk of serious diseases such as cancer, diabetes, and heart diseases. Many people with obesity replace sugar with non-nutritive or artificial sweeteners to maintain the sweet taste but lower the calorie, or energy, intake. However, the effect these sweeteners have on weight prevention remains controversial.

Societal and environmental changes such as an increase in energy-dense or high-calorie food and a decrease in physical activity contribute to the obesity epidemic. Individuals diagnosed with obesity are recommended to increase physical activity and make healthier diet choices. As part of the healthy diet choices, they are recommended to increase the amount of fruit, vegetables, legumes, and nuts but limit energy intake from fat and sugar. To keep individuals adhering to the healthy changes in their diet, many use non-nutritive or artificial sweeteners to keep their calorie intake low but maintain the sweet taste they enjoy. Nutritive or natural sweeteners, on the other hand, include fructose (found in fruits) and honey.

Safety Concerns about Artificial Sweeteners

However, there are some serious safety concerns about the use of artificial sweeteners. Previous observational studies have indicated that the use of non-nutritive sweeteners leads to weight gain, whereas intervention studies have shown the opposite. The study design and bias are a few reasons why the results remain controversial, with bias introduced by both the study design and industry-sponsored research. Also, previous research has focused mainly on weight management and not whether there are any links between the use of artificial sweeteners and the general health and lifestyle of the participants.

Are Artificial Sweeteners Associated with an Unhealthy Lifestyle?

Norwegian researchers recently published a study in BMC Obesity that investigated whether the use of artificial sweeteners such as stevia is associated with an unhealthy lifestyle in morbidly obese individuals. The study included 100 participants (83 women and 17 men) with an average age of 44 years who were classified as morbidly obese (their BMI was greater than 40 kg/m2) and had an obese-related comorbidity. The researchers collected information about the participant’s physical and mental health, demographics, and dietary habits, along with taking a blood screen.

The results showed that the total intake of artificial sweeteners ranged from zero to 43 units per day, where one unit was defined as 100 mL of beverages with artificial sweeteners or two tablets/units of artificial sweetener for coffee or tea. The average intake per day was 3.3 units, however, no association between BMI and daily artificial sweetener intake was observed.

Artificial Sweeteners Associated with Reduced Physical and Mental Health

Interestingly though, the consumption of artificial sweeteners did show an association with an unhealthy lifestyle, with a reduction in physical activity, fatigue, diarrhea, diabetes and reduced well-being observed. Also, an increase in the total energy intake, carbohydrates, sugar, and salt, along with a reduction in the intake of vitamins A and D were observed.

While the clinical significance of these results is uncertain and long-term outcomes is unknown, they do indicate that the use of artificial sweeteners by morbidly obese individuals is associated with reduced physical and mental health, worse dietary habits, an increase in total energy intake (including sugar) and hence an unhealthy lifestyle. Future studies which include a larger sample size, along with healthy, overweight and obese individuals are needed to elucidate whether these results are consistent in the general population.

Written by Lacey Hizartzidis, PhD

Reference: Winther R, Aasbrenn M, Farup PG. Intake of non-nutritive sweeteners is associated with an unhealthy lifestyle: a cross-sectional study in subjects with morbid obesity. BMC Obes. 2017 Dec 27;4:41. doi: 10.1186/s40608-017-0177-x.