For 2 months, the participants ate a calorie-restricted diet with the goal of losing at least 5% of their body weight. Over the next 10 months, the goal was to maintain body weight.

The weight maintenance diet was designed to contain less than 10% of calories from added sugar. In the intervention group, the goal was to replace as many sugar-containing products as possible with products that contained “sweetness enhancers”, which included high-potency sweeteners (e.g., aspartame, acesfulame-K), sugar alcohols (e.g., erythritol), slowly digestible carbohydrates (e.g., isomaltulose), and sweet fiber oligosaccharides. In the control group, products that contained sweetness enhancers were not allowed.

After 12 months, the participants in the intervention group lost 1.6 kg (3.5 lbs) more than the control group (−7.2 kg vs. −5.6 kg, −15.8 lb vs. −12.3 lb). The decrease in hip circumference was also greater in the intervention group (−5.1 cm vs. −3.4 cm or −2.0 in vs. −1.3 in).

Weight loss in the two study groups

The number of adverse events related to gastrointestinal symptoms was higher in the intervention group, specifically abdominal pain or cramps, loose stools, and gas. Biomarkers of cardiometabolic health did not differ between groups (e.g., blood pressure, LDL-C, triglycerides, HbA1c, insulin).

Replacing sugar with sugar alternatives to improve weight loss Original paper