Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: systematic review and meta-analysis
Open accessAbstract
There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions.
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There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss while other research suggests an association with weight gain.
“There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss (233-235) while other research suggests an association with weight gain (236,237).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [235]
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The Importance of Sweet Beverage Definitions When Targeting Health Policies—The Case of Switzerland
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“For instance, it has been suggested that while it may contribute toweight reduction(37), some important safety issues have also been detected(38,39).”
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“caloric sweeteners, and generally has neutral effects on total energy intakes relative to unsweetened (mainly water) controls [10,11,15,16].”
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“Most RCTs on NNS and weight loss have been reported among overweight/ obese individuals [26–28] and our study is one of the first to show similar weight loss in adults with T2D.”
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“…all age groups combined, and speci fi c subpopulations (e.g., populations with type 1 diabetes mellitus/T2D [44 – 46]; populations strati fi ed by BW status [11,32,39], sex [34,47,48], age [34,37,47], country [47], and baseline LCSB/SSB consumption status [11]) are included in the OSF database.”
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“[17] In another meta-analysis by Movahedian et al., reduction in body weight and fat mass was reported in NNS users.”
Singh, A. K., Singh, A., Singh, R., Joshi, S., & Misra, A. (2023) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2023.102829 · Cited by 10 · see citing works
Chatelan, A., Raeisi‐Dehkordi, H., & Salehi‐Abargouei, A. (2024) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2024.102105 · Cited by 9 · see citing works
Diet, inflammation, and cardiovascular disease
Vahid, F., Chiriboga, D. E., Bohn, T., & Hébert, J. R. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822130-3.00015-6 · Cited by 9 · see citing works
Stadelmaier, J., Rehfuess, E. A., Forberger, S., Eisele‐Metzger, A., Nagavci, B., Schünemann, H. J., Meerpohl, J. J., & Schwingshackl, L. (2022) · European Journal of Public Health · doi:10.1093/eurpub/ckac077 · Cited by 8 · see citing works
Potential Effects of Low-Calorie Sweeteners on Human Health
Chen, H.-P., Kao, Y., Lin, M., Lee, C., Wu, H., & Kuo, H. (2025) · Nutrients · doi:10.3390/nu17172726 · Cited by 7 · see citing works
“Although the substitution of sugar with LCS has traditionally been considered supportive of weight control, several studies have indicated that sucralose may worsen certain health outcomes, particularly those related to glycemic regulation [9].”
Zhang, J., Yan, L., Li, F., He, M., Li, J., Zhang, S., Zhao, W., Tang, Y., Li, Y., Xiong, J., et al. (2024) · Pediatric Obesity · doi:10.1111/ijpo.13096 · Cited by 7 · see citing works
Bielat, A. D., Rogers, P. J., & Appleton, K. M. (2024) · British Journal Of Nutrition · doi:10.1017/s0007114524003209 · Cited by 7 · see citing works
Clearing the Myths around non-nutritive/noncaloric Sweeteners: An Efficacy and Safety Evaluation
TIWASKAR, M. H., & Viswanathan, V. (2022) · Journal of the Association of Physicians of India · doi:10.5005/japi-11001-0029 · Cited by 7 · see citing works
Monge, A. M., Ferriday, D., Heckenmueller, S., Brunstrom, J. M., & Rogers, P. J. (2022) · Appetite · doi:10.1016/j.appet.2022.106273 · Cited by 7 · see citing works
The role of information in nudging Chinese consumers from choosing sugar to alternative sweeteners
Guan, L., Jin, S., & Lin, W. T. (2024) · China Economic Review · doi:10.1016/j.chieco.2024.102233 · Cited by 6 · see citing works
Zhang, L., Ma, C., Huang, H., Li, D., Zhang, D., Wu, T., Chu, M., & Hu, F. (2024) · Food & Function · doi:10.1039/d4fo03761h · Cited by 6 · see citing works
Li, D., Han, L., Yu, Z., Teng, X., Ma, Y., & Wang, D. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02654-w · Cited by 6 · see citing works
Espinosa, A., Pacheco, L. S., Wan, Y., Sun, Q., Hu, F. B., Tobias, D. K., Willett, W. C., & Mattei, J. (2026) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2026.101261 · Cited by 6 · see citing works
Gajewska, D., Lange, E., Kęszycka, P. K., Białek-Dratwa, A., Gudej, S., Świąder, K., Giermaziak, W., Kostelecki, G., Kret, M., Marlicz, W. M., et al. (2024) · Journal of Health Inequalities · doi:10.5114/jhi.2024.141201 · Cited by 5 · see citing works
“A meta-analysis of 20 randomised clinical trials showed that study participants consuming products with intense sweeteners showed significantly lower body weight compared to people not consuming this type of products [85].”
Marcela Reyes, J., León, C. P., Ortega, A., Pemjean, I., Corvalán, C., & Garmendia, M. L. (2024) · Public Health Nutrition · doi:10.1017/s1368980024001745 · Cited by 5 · see citing works
“Although results are still inconclusive (9,10) , some health associations such as the Institute of Medicine of the United States (IOM-USA) and the American Academy of Pediatrics have concluded that consumption of NNS in children should not be promoted until all its potential health effects are…”
ResultHuman body weight, nutrients, and foods: a scoping review
Hjelmesaeth, J. S., & Sjöberg, A. (2022) · Food & Nutrition Research · doi:10.29219/fnr.v66.8814 · Cited by 5 · see citing works
“Non-nutritive sweeteners One recent SR and MA of 20 randomised controlled trial (RCTs) (15) including 2,914 participants with the duration of 4–77 weeks showed that participants consuming NNS showed small but significant weight/body mass index (BMI) differences favoring NNS compared with non-users (–1.”
BackgroundWen, J., Wu, Q., Li, S., Liu, Y., & Wen, D. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf094 · Cited by 4 · see citing works
Ayoub‐Charette, S., Kavanagh, M. E., Khan, T. A., & Sievenpiper, J. L. (2025) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2025-0068 · Cited by 4 · see citing works
Ko, H.-K., Shi, J., Eidenberger, T., Shi, W., & McCabe, C. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121552 · Cited by 4 · see citing works
Sweeteners: Sensory properties, digestion, consumption trends, and health effects
Mattes, R. D., Tan, S., & Tucker, R. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-821848-8.00014-7 · Cited by 4 · see citing works
Non-nutritive sweeteners and body weight management: another brick in the wall of evidence
Rogers, P. J. (2023) · International Journal of Obesity · doi:10.1038/s41366-023-01419-w · Cited by 4 · see citing works
“This result sits comfortably within the range of results identi fi ed in meta-analyses [4, 5] of previous RCTs making this comparison, which collectively show no difference for body weight between NNS beverages and water.”
Galicia-Ayala, C., Klünder‐Klünder, M., Vilchis-Ordóñez, A., López-Martı́nez, B., & Miranda‐Lora, A. L. (2025) · Nutrition · doi:10.1016/j.nut.2025.112938 · Cited by 3 · see citing works
Cogan, B., & Cooper, J. A. (2023) · Appetite · doi:10.1016/j.appet.2023.107133 · Cited by 3 · see citing works
The effect of sweeteners on carbohydrate metabolism, metabolic parameters and intestinal microbiota
Silina, N. V., Mazurina, N. V., Ershova, E. V., & Komshilova, K. A. (2024) · Obesity and metabolism · doi:10.14341/omet13020 · Cited by 3 · see citing works
Low‐ or No‐Energy Sweeteners and Body Weight Management: Dissecting a “Minor” Effect
Bellisle, F. (2025) · Obesity Reviews · doi:10.1111/obr.13937 · Cited by 2 · see citing works
“Although an early RCT suggested that aspartame administered in capsules could decrease later food intake [68], LNES delivered in capsules had no effect on weight [36, 37] or glycemia [69].”
Ko, H.-K., Shi, J., Eidenberger, T., Shi, W., & McCabe, C. (2025) · Nutritional Neuroscience · doi:10.1080/1028415x.2025.2508772 · Cited by 3 · see citing works
“A recent meta-analysis finds that replacing sugar with non-nutrient sweeteners leads to weight reduction, particularly in participants overweight/obese under an unrestricted diet [5].”
The Effect of Non‐Nutritive Sweeteners' Consumption on Body Weight: A Randomized‐Controlled Trial
Daher, M. I., Darazi, E. E., Kacim, M., Hobeika, M., & Sacre, Y. (2025) · Food Science & Nutrition · doi:10.1002/fsn3.70691 · Cited by 3 · see citing works
Artificial Sweeteners Perturbed Liver Enzymes in Rat Model
Dawood, M. N., Jasim, S. A. H., Fadel, M. A., & Thanoon, I. A.-J. (2022) · Pharmacognosy Journal · doi:10.5530/pj.2022.14.135 · Cited by 3 · see citing works
Sucralose Targets the Insulin Signaling Pathway in the SH-SY5Y Neuroblastoma Cell Line
Čović, M., Zjalić, M., Mihajlović, L., Pap, M., Wagner, J., Mandić, D., Debeljak, Ž., & Heffer, M. (2023) · Metabolites · doi:10.3390/metabo13070817 · Cited by 3 · see citing works
Tang, C. S., Mars, M., James, J., de Graaf, K. C., & Appleton, K. M. (2021) · Foods · doi:10.3390/foods10061172 · Cited by 3 · see citing works
“Consistent with work demonstrating benefits for weight management [27,28], LNCS use continues to be predominantly associated with concerns over bodyweight [14,16,29-31].”
BackgroundA Review of Low- and No-Calorie Sweetener Safety and Weight Management Efficacy
Mattes, R. D., Rivera, B. N., Rutigliani, G., Rogers, S., Mendoza, I. D., Wang, L., Beckemeier, K., & Wikoff, D. S. (2024) · Nutrition Today · doi:10.1097/nt.0000000000000723 · Cited by 2 · see citing works
Boxall, L. R., Eskandari, F., Wallis, J., Bielat, A. D., & Appleton, K. M. (2025) · Advances in Nutrition · doi:10.1016/j.advnut.2025.100449 · Cited by 2 · see citing works
“LCS are commonly recognized as safe [10,11], widely used within the food industry [10,11], and recent reviews suggest bene fi ts for reducing energy intake and body weight (BW), when compared with the consumption of sugar [12 – 14].”
Najafi, A., Moghtaderi, F., Seyedjafari, B., Rostampour, K., & Salehi‐Abargouei, A. (2025) · Scientific Reports · doi:10.1038/s41598-025-00612-3 · Cited by 3 · see citing works
Hamedi, F., Asemani, S., Prabahar, K., Jourabchi‐Ghadim, N., & Ostadrahimi, A. (2024) · BioSocial Health Journal. · doi:10.34172/bshj.22 · Cited by 2 · see citing works
“26 The selection of studies based on the inclusion criteria differs among each study, which would have contributed to this variation in results.”
BackgroundPyrogianni, V. (2025) · Food Science and Nutrition Cases · doi:10.1079/fsncases.2025.0008 · Cited by 1 · see citing works
Beyond Added Sugar Reduction: A Narrative Review of Policies to Address Nonsugar Sweeteners
Krieger, J. W., Davis, J. N., Ng, S. W., Nguyen, M., Zimová, A., Hedrick, V. E., Malik, V., Taillie, L. S., Sylvetsky, A. C., & Falbe, J. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101479 · Cited by 1 · see citing works
Choe, S., Sa, J., Chaput, J., & Kim, D. (2021) · Korean Journal of Pediatrics · doi:10.3345/cep.2021.00409 · Cited by 1 · see citing works
USE OF LOW-CALORIE SWEETENERS IN TREATING OBESITY
Reimisz, P. (2023) · Health Problems of Civilization · doi:10.5114/hpc.2023.128034 · Cited by 1 · see citing works
Cardiovascular Therapeutics from Natural Sources
Sreedevi, K., & Sandeep, P. M. (2024) · Springer eBooks · doi:10.1007/978-981-99-9183-9_17 · Cited by 1 · see citing works
Aspartame: A review of functional properties and physiology impacts of aspartame
Zhang, Y. (2024) · Theoretical and Natural Science · doi:10.54254/2753-8818/45/20240521 · Cited by 1 · see citing works
Nolden, A. A., & Makame, J. (2024) · Nutrients · doi:10.3390/nu17010032 · Cited by 1 · see citing works
“In a meta-analysis of 20 studies, Laviada-Molina and colleagues (2020) concluded that using LNCSs was associated with a significant reduction in body weight and BMI among overweight and obese consumers [20].”
Siswanto, S. (2025) · Journal of Applied Nursing and Health · doi:10.55018/janh.v7i1.288 · Cited by 1 · see citing works
Rodríguez, G. L., Galván, M., Galván-Valencia, O., & Castillo, J. G. (2025) · Beverages · doi:10.3390/beverages11030069 · Cited by 1 · see citing works
Effects of non‐nutritive sweeteners on diabetes: Comments on a Cochrane review
Laviada‐Molina, H., Espinosa‐Marrón, A., Martinez-Portilla, R. J., & Molina-Seguí, F. (2021) · Diabetic Medicine · doi:10.1111/dme.14520 · Cited by 1 · see citing works
Gut microbiota response to sucralose or rebaudioside A in rats under two dietary conditionsPreprint
Ramos-García, M., Mendoza, A. D. G., García-Vázquez, C., Martínez‐Magaña, J. J., Olvera‐Hernández, V., Martínez‐López, M. C., Díaz-Zagoya, J. C., Álvarez-Villagómez, C. S., Juárez-Rojop, I. E., Nicolini, H., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2802760/v1 · Cited by 1 · see citing works
Pyrogianni, V. (2020) · Journal of American College Health · doi:10.1080/07448481.2020.1767114
“While there has been much conversation regarding the potential for NNSs to cause weight gain, such an effect has been refuted by collective evidence from randomized controlled trials (RCTs) – the most reliable type of research for evaluation of proposed effects.(5,6) Webb et al(1) cite a recently conducted scoping rev…”
BackgroundResultEffects of non‐nutritive sweeteners on diabetes: Reply to Laviada‐Molina et al.
Lohner, S., de Gaudry, D. K., Toews, I., Ferenci, T., & Meerpohl, J. J. (2021) · Diabetic Medicine · doi:10.1111/dme.14589
Non-nutritive Sweetened Beverages and Cardiometabolic Risk
McGlynn, N. D. (2020) · TSpace (University of Toronto)
The defamation of low-energy sweeteners: Crop circles, zombies, and zebrasPreprint
Mela, D. J. (2022) · doi:10.31219/osf.io/nh6ay
Is consumption of artificially sweetened beverages associated with obesity in adults?
Raetz, J., Veltri, K., Stine-Rowe, A., & Buck, L. (2022) · Evidence-Based Practice · doi:10.1097/ebp.0000000000001672
Kardiyovasküler Sağlığı İyileştirmeye Yönelik Diyet Yaklaşımları
Dedeler, E., AYHAN, Z., TOYMAN, E., & Kaner, G. (2023) · İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.61399/ikcusbfd.1206442
Ramos-García, M., Mendoza, A. D. G., García-Vázquez, C., Martínez‐Magaña, J. J., Olvera‐Hernández, V., Martínez‐López, M. C., Díaz-Zagoya, J. C., Álvarez-Villagómez, C. S., Juárez‐Rojop, I. E., Nicolini, H., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-2802760/v2
Shi, L. S., Liu, Y., Duan, Y., Liu, T., Zhang, B., Zhu, W., Kang, J., & Zhang, K.-R. (2024) · Research Square · doi:10.21203/rs.3.rs-3867242/v1
Süßstoffe und ihre Wirkung auf das Körpergewicht
Kabisch, S. (2024) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/a-2227-4357
“Es zeigt sich, dass diejenigen Gruppen mit Süßstoffexposition konsistent eine besse - re Gewichtsentwicklung aufweisen, bei Erwachsenen [20] und bei Kindern bzw.”
BackgroundAssessment of Knowledge and Perceptions of Pakistani Adults about Non-nutritive Sweeteners
Naveed, A., Khan, B., Asghar, K., Noor, M., Arshad, M., Sultan, T., & Mazhar, M. (2024) · DIET FACTOR (Journal of Nutritional & Food Sciences) · doi:10.54393/df.v5i01.104
Süßstoffe und ihre Wirkung auf das Körpergewicht
Kabisch, S. (2024) · Diabetes aktuell · doi:10.1055/a-2329-5194
小林, 俊. (2024) · Nihon Ika Daigaku Igakkai Zasshi · doi:10.1272/manms.20.261
- Authors
- Laviada‐Molina, H., Molina‐Segui, F., Pérez‐Gaxiola, G., Cuello‐García, C., Arjona‐Villicaña, R., Espinosa‐Marrón, A., & Martinez‐Portilla, R. J.
- Affiliations
- Universidad Marista de Mérida (MX)
- Department of Human Nutrition and Metabolism Research, Health Sciences School Universidad Marista de Merida Mérida Mexico
- Pediatric Hospital of Sinaloa (MX)
- McMaster University (CA)
- Endocrinology Service Hospital Regional de Alta Especialidad de la Peninsula de Yucatan Merida Mexico
- Nuffield Department of Primary Health Sciences, Radcliffe Observatory Quarter University of Oxford Centre for Evidence‐Based Medicine Oxford UK
- ORCID
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2020-03-25
- Volume
- 21
- Issue
- 7
- Pages
- e13020-e13020
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W3014022032
- Cited by
- 115
- References
- 44
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 25 · 2023: 16 · 2022: 19 · 2021: 13 · 2020: 7
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Biochemical Analysis and Sensing Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Keywords
- artificial sweeteners, body weight, body mass index, obesity, overweight, sucrose replacement, weight loss diet, sugar consumption
- MeSH terms
- Body Weight, Diet, Humans, Obesity, Body Mass Index, Non-Nutritive Sweeteners
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