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No-Cal Drinks Yield Bigger Weight Loss

Replacing calorie-laden beverages with water or diet drinks may be effective at shedding weight and improving other cardiometabolic parameters in the short term.

According to Deborah Tate, PhD, of the University of North Carolina’s Gillings School of Global Public Health in Chapel Hill, in the three-arm trial, there were no significant between-group differences in the percentage of weight lost over six months, but participants in the combined substitution groups were significantly more likely to lose at least 5% of their body weight (OR 2.1, P<0.05) than those who were told only to make healthy dietary choices (the control group),

Participants in the substitution groups were told to replace at least two caloric drinks a day with either water or diet beverages.

Those in the water group had significantly greater improvements in systolic blood pressure and fasting glucose compared with the controls (P<0.05 for both). 

Replacing caloric beverages with noncaloric alternatives, without intensive monitoring of other diet and physical activity, resulted in small but significant weight changes that may be substantial if applied at a population level. 

Data from the National Health and Nutrition Examination Survey (NHANES) have shown that about 60% of adults report drinking sugar-sweetened beverages, and that adults consume an average of 300 calories per day from such drinks. 

To see whether substituting noncaloric alternatives for caloric drinks could make a difference in weight loss, Tate and colleagues conducted the CHOICE (Choose Healthy Options Consciously Everyday) study. Participants were overweight or obese (body mass index 25 to less than 50 kg/m2) and ages 18 to 65 (mean 42). To enter the study, they had to report consuming at least 280 calories per day from caloric beverages at baseline, not counting unsweetened milk. 

The researchers randomized 315 people — 105 in the control group, 104 in the diet beverage group, and 106 in the water group. 

All three groups attended a monthly group session. The control group received information on making healthy dietary and lifestyle choices, but no guidance was given regarding drinks. 

The focus of the sessions in the two substitution groups was on replacing at least 200 calories per day from drinks as a means to lose weight. The participants received handouts covering the information that was being discussed in the sessions with the control group. The researchers provided monthly supplies of either bottled water or diet beverages of the participants’ choosing. 

Through six months, participants in the diet beverage group cut an average of 218 drink calories per day, those in the water group cut an average of 148, and those in the control group cut an average of 86. The differences between the substitution groups and the control group were both significant (P<0.05). Food intake decreased slightly in all three groups. 

Looking at the substitution groups individually, only the participants in the diet beverage group were more likely to lose 5% or more of their body weight (OR 2.3, P<0.05). That is likely the result of better adherence to drink replacement compared with the water group, Tate said. 

Blood pressure, fasting glucose, and hydration improved in both substitution groups, although the only significant differences versus the control group were in the water group — for systolic blood pressure and fasting glucose. 

Tate acknowledged that the study was limited by the predominantly female patient population (85%), the use of self-reported measures of diet, and the short duration. 

Practice Pearls:  

  • Point out that in this study, obese patients who replaced caloric beverages with water or diet beverages were more likely than controls to achieve a clinically meaningful weight loss at six months.
  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Tate D, et al “Replacing caloric beverages with water or diet beverages for weight loss in adults: results of a six-month randomized controlled trial” OBESITY 2011; Abstract 97-OR.