Danielle Ostendorf : The Effects of Water and Non-Nutritive Sweetened Beverages on Weight Loss During a 12- week Weight Loss Treatment Program

8/12/2019 Danielle Ostendorf : The Effects of Water and Non-Nutritive Sweetened Beverages on Weight Loss During a 12- week Weight Loss Treatment Program

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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

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Danielle Ostendorf : The Effects of Water and Non-Nutritive Sweetened Beverages on Weight Loss During a 12- week Weight Loss Treatment Program