A review of the effectiveness of aspartame in helping with weight control

Abstract

Summary Strategies to reverse the upward trend in obesity rates need to focus on both reducing energy intake and increasing energy expenditure. The provision of low- or reduced-energy-dense foods is one way of helping people to reduce their energy intake and so enable weight maintenance or weight loss to occur. The use of intense sweeteners as a substitute for sucrose potentially offers one way of helping people to reduce the energy density of their diet without any loss of palatability.
This report reviews the evidence for the effect of aspartame on weight loss, weight maintenance and energy intakes in adults and addresses the question of how much energy is compensated for and whether the use of aspartame-sweetened foods and drinks is an effective way to lose weight.
All studies which examined the effect of substituting sugar with either aspartame alone or aspartame in combination with other intense sweeteners on energy intake or bodyweight were identified. Studies which were not randomised controlled trials in healthy adults and which did not measure energy intakes for at least 24 h (for those with energy intakes as an outcome measure) were excluded from the analysis. A minimum of 24-h energy intake data was set as the cut-off to ensure that the full extent of any compensatory effects was seen. A total of 16 studies were included in the analysis. Of these 16 studies, 15 had energy intake as an outcome measure. The studies which used soft drinks as the vehicle for aspartame used between 500 and about 2000 ml which is equivalent to about two to six cans or bottles of soft drinks every day.
A significant reduction in energy intakes was seen with aspartame compared with all types of control except when aspartame was compared with non-sucrose controls such as water. The most relevant comparisons are the parallel design studies which compare the effects of aspartame with sucrose. These had an overall effect size of 0.4 standardised difference (SD). This corresponds to a mean reduction of about 10% of energy intake. At an average energy intake of 9.3 MJ/day (average of adult men and women aged 19–50 years) this is a deficit of 0.93 MJ/day (222 kcal/day or 1560 kcal/week), which would be predicted (using an energy value for obese tissue of 7500 kcal/kg) to result in a weight loss of around 0.2 kg/week with a confidence interval 50% either side of this estimate.
Information on the extent of compensation was available for 12 of the 15 studies. The weighted average of these figures was 32%. Compensation is likely to vary with a number of factors such as the size of the caloric deficit, the type of food or drink manipulated, and timescale. An estimate of the amount of compensation with soft drinks was calculated from the four studies which used soft drinks only as the vehicle. A weighted average of these figures was 15.5%.
A significant reduction in weight was seen. The combined effect figure of 0.2 SD is a conservative figure as it excludes comparisons where the controls gained weight because of their high-sucrose diet and the long-term follow-up data in which the aspartame groups regained less weight than the control group. An effect of 0.2 SD corresponds to about a 3% reduction in bodyweight (2.3 kg for an adult weighing 75 kg). Given the weighted average study length was 12 weeks, this gives an estimated rate of weight loss of around 0.2 kg/week for a 75-kg adult.
The meta-analyses demonstrate that using foods and drinks sweetened with aspartame instead of sucrose results in a significant reduction in both energy intakes and bodyweight. Meta-analyses both of energy intake and of weight loss produced an estimated rate of weight loss of about 0.2 kg/week. This close agreement between the figure calculated from reductions in energy intake and actual measures of weight loss gives confidence that this is a true effect. The two meta-analyses used different sets of studies with widely differing designs and controls. Although this makes comparisons between them difficult, it suggests that the final figure of around 0.2 kg/week is robust and is applicable to the variety of ways aspartame-containing foods are used by consumers.
This review has shown that using foods and drinks sweetened with aspartame instead of those sweetened with sucrose is an effective way to maintain and lose weight without reducing the palatability of the diet. The decrease in energy intakes and the rate of weight loss that can reasonably be achieved is low but meaningful and, on a population basis, more than sufficient to counteract the current average rate of weight gain of around 0.007 kg/week. On an individual basis, it provides a useful adjunct to other weight loss regimes.
Some compensation for the substituted energy does occur but this is only about one-third of the energy replaced and is probably less when using soft drinks sweetened with aspartame. Nevertheless, these compensation values are derived from short-term studies. More data are needed over the longer term to determine whether a tolerance to the effects is acquired.
To achieve the average rate of weight loss seen in these studies of 0.2 kg/week will require around a 220-kcal (0.93 MJ) deficit per day based on an energy value for obese tissue of 7500 kcal/kg. Assuming the higher rate of compensation (32%), this would require the substitution of around 330 kcal/day (1.4 MJ/day) from sucrose with aspartame (which is equivalent to around 88 g of sucrose). Using the lower estimated rate of compensation for soft drinks alone (15.5%) would require the substitution of about 260 kcal/day (1.1 MJ/day) from sucrose with aspartame. This is equivalent to 70 g of sucrose or about two cans of soft drinks every day.

Full text

© 2006 British Nutrition Foundation
Nutrition Bulletin
,
31
, 115 –128
115
Blackwell Publishing LtdOxford, UKNBUNutrition Bulletin1471-98272006 British Nutrition Foundation
? 2006
31
2115128
Review Article
Effect of aspartame on weight controlA. de la Hunty
et al.
Correspondence
: Anne de la Hunty, Ashwell Associates (Europe) Ltd, Ashwell Street, Ashwell, Hertfordshire SG7 5PZ, UK.
E-mail: annedelahunty@btinternet.com
REVIEW
A review of the effectiveness of
aspartame in helping with weight
control
A. de la Hunty*, S. Gibson
†
and M. Ashwell*
‡
*Ashwell Associates (Europe) Ltd, Ashwell, Hertfordshire, UK
†
SiG-Nurture Ltd, Guildford, Surrey, UK
‡
Oxford Brookes University, Headington Campus, Oxford, UK
Summary
Strategies to reverse the upward trend in obesity rates need to focus on both reduc-
ing energy intake and increasing energy expenditure. The provision of low- or
reduced-energy-dense foods is one way of helping people to reduce their energy
intake and so enable weight maintenance or weight loss to occur. The use of intense
sweeteners as a substitute for sucrose potentially offers one way of helping people
to reduce the energy density of their diet without any loss of palatability.
This report reviews the evidence for the effect of aspartame on weight loss, weight
maintenance and energy intakes in adults and addresses the question of how much
energy is compensated for and whether the use of aspartame-sweetened foods and
drinks is an effective way to lose weight.
All studies which examined the effect of substituting sugar with either aspartame
alone or aspartame in combination with other intense sweeteners on energy intake
or bodyweight were identified. Studies which were not randomised controlled trials
in healthy adults and which did not measure energy intakes for at least 24 h (for
those with energy intakes as an outcome measure) were excluded from the analysis.
A minimum of 24-h energy intake data was set as the cut-off to ensure that the full
extent of any compensatory effects was seen. A total of 16 studies were included in
the analysis. Of these 16 studies, 15 had energy intake as an outcome measure. The
studies which used soft drinks as the vehicle for aspartame used between 500 and
about 2000 ml which is equivalent to about two to six cans or bottles of soft drinks
every day.
A significant reduction in energy intakes was seen with aspartame compared with
all types of control except when aspartame was compared with non-sucrose con-
trols such as water. The most relevant comparisons are the parallel design studies
which compare the effects of aspartame with sucrose. These had an overall effect
size of 0.4 standardised difference (SD). This corresponds to a mean reduction of
about 10% of energy intake. At an average energy intake of 9.3 MJ/day (average of
adult men and women aged 19–50 years) this is a deficit of 0.93 MJ/day (222 kcal/
day or 1560 kcal/week), which would be predicted (using an energy value for obese

116
A. de la Hunty
et al.
© 2006 British Nutrition Foundation
Nutrition Bulletin
,
31
, 115 –128
tissue of 7500 kcal/kg) to result in a weight loss of around 0.2 kg/week with a con-
fidence interval 50% either side of this estimate.
Information on the extent of compensation was available for 12 of the 15 studies.
The weighted average of these figures was 32%. Compensation is likely to vary with
a number of factors such as the size of the caloric deficit, the type of food or drink
manipulated, and timescale. An estimate of the amount of compensation with soft
drinks was calculated from the four studies which used soft drinks only as the vehi-
cle. A weighted average of these figures was 15.5%.
A significant reduction in weight was seen. The combined effect figure of 0.2 SD
is a conservative figure as it excludes comparisons where the controls gained weight
because of their high-sucrose diet and the long-term follow-up data in which the
aspartame groups regained less weight than the control group. An effect of 0.2 SD
corresponds to about a 3% reduction in bodyweight (2.3 kg for an adult weighing
75 kg). Given the weighted average study length was 12 weeks, this gives an esti-
mated rate of weight loss of around 0.2 kg/week for a 75-kg adult.
The meta-analyses demonstrate that using foods and drinks sweetened with
aspartame instead of sucrose results in a significant reduction in both energy intakes
and bodyweight. Meta-analyses both of energy intake and of weight loss produced
an estimated rate of weight loss of about 0.2 kg/week. This close agreement
between the figure calculated from reductions in energy intake and actual measures
of weight loss gives confidence that this is a true effect. The two meta-analyses used
different sets of studies with widely differing designs and controls. Although this
makes comparisons between them difficult, it suggests that the final figure of around
0.2 kg/week is robust and is applicable to the variety of ways aspartame-containing
foods are used by consumers.
This review has shown that using foods and drinks sweetened with aspartame
instead of those sweetened with sucrose is an effective way to maintain and lose
weight without reducing the palatability of the diet. The decrease in energy intakes
and the rate of weight loss that can reasonably be achieved is low but meaningful
and, on a population basis, more than sufficient to counteract the current average
rate of weight gain of around 0.007 kg/week. On an individual basis, it provides a
useful adjunct to other weight loss regimes.
Some compensation for the substituted energy does occur but this is only about
one-third of the energy replaced and is probably less when using soft drinks sweet-
ened with aspartame. Nevertheless, these compensation values are derived from
short-term studies. More data are needed over the longer term to determine whether
a tolerance to the effects is acquired.
To achieve the average rate of weight loss seen in these studies of 0.2 kg/week will
require around a 220-kcal (0.93 MJ) deficit per day based on an energy value for
obese tissue of 7500 kcal/kg. Assuming the higher rate of compensation (32%), this
would require the substitution of around 330 kcal/day (1.4 MJ/day) from sucrose
with aspartame (which is equivalent to around 88 g of sucrose). Using the lower
estimated rate of compensation for soft drinks alone (15.5%) would require the
substitution of about 260 kcal/day (1.1 MJ/day) from sucrose with aspartame. This
is equivalent to 70 g of sucrose or about two cans of soft drinks every day.

Effect of aspartame on weight control
117
© 2006 British Nutrition Foundation
Nutrition Bulletin
,
31
, 115 –128
Keywords:
aspartame
,
energy intakes
,
intense sweeteners
,
meta-analysis
,
obesity
,
weight
loss
Introduction
Obesity is one of the major public health issues in the
UK. Around two-thirds of the population are now over-
weight or obese, a quadruple increase in 25 years. If the
present rates of increase continue, obesity will soon
overtake smoking as the biggest cause of premature
death in the UK. The economic costs of obesity and
overweight are estimated to be between 6.6 and 7.4 bil-
lion pounds per year (Health Select Committee 2004).
Obesity increases the risk of cancers, including breast
cancer, endometrial cancer and colon cancer, diabetes,
coronary heart disease, hypertension, insulin resistance,
gall bladder disease and osteoarthritis. The psychologi-
cal consequences of obesity are also huge and include
anxiety, depression, low self-esteem and lack of confi-
dence. Suicide is more common in obese people than
normal-weight people (WHO 1998). Life expectancy is
reduced by about 9 years in obese people, and by even
more if they also smoke.
Strategies to reverse the upward trend in obesity rates
need to focus on both reducing energy intake and
increasing energy expenditure. The provision of low- or
reduced-energy-dense foods is one way of helping peo-
ple to reduce their energy intake and so enable weight
maintenance or weight loss to occur. The use of intense
sweeteners as a substitute for sucrose potentially offers
one way of helping people to reduce the energy density
of their diet without any loss of palatability. This is par-
ticularly the case with soft drinks as it is possible to
reduce the energy content of the drink to practically zero
as the energy content is almost entirely provided by
sucrose or similar.
However, the usefulness of intense sweeteners as an
aid to weight loss was questioned after reports that sub-
jects had higher hunger ratings after drinking an aspar-
tame-sweetened drink than after plain water (Blundell
& Hill 1986). Blundell and Hill argued that any calorie
savings achieved with intense sweeteners were false and
were likely to be offset by increased energy intakes at
subsequent meals. Although these findings were not
replicated by other groups, the question of how much
energy compensation occurs with the use of intense
sweeteners has been the subject of much research.
This report reviews the evidence for the effect of
aspartame on weight loss, weight maintenance and
energy intakes in adults and addresses the question of
how much energy is compensated for and whether the
use of aspartame-sweetened foods and drinks is an effec-
tive way to lose weight.
Methods and summary of data
All studies which examined the effect of substituting
sugar with either aspartame alone or aspartame in
combination with other intense sweeteners on energy
intake or bodyweight in adults were identified. Reviews
by Kanders
et al
. (1996), Rolls and Shide (1996),
Drewnowski (1999), Vermunt
et al
. (2003) and Benton
(2005) were used as a starting point for the search. Stud-
ies which were not randomised controlled trials in
healthy adults and which did not measure energy
intakes for at least 24 h (for those with energy intakes as
an outcome measure) were excluded from the analysis.
A minimum of 24-h energy intake data was set as the
cut-off to ensure that the full extent of any compensa-
tory effects was seen.
A total of 16 studies were included in the analysis. Of
these 16 studies, 15 had energy intake as an outcome
measure (Porikos
et al
. 1977, 1982; Foltin
et al
. 1988,
1990, 1992; Evans 1989; Mattes 1990; Tordoff & All-
eva 1990; Naismith & Rhodes 1995; Blackburn
et al
.
1997; Gatenby
et al
. 1997; Lavin
et al
. 1997; Reid &
Hammersley 1998; Raben
et al
. 2002; Van Wymelbeke
et al
. 2004) and 9 had weight loss (Porikos
et al
. 1977,
1982; Kanders
et al
. 1988, 1990; Tordoff & Alleva
1990; Naismith & Rhodes 1995; Blackburn
et al
. 1997;
Gatenby
et al
. 1997; Reid & Hammersley 1998; Raben
et al
. 2002). The included studies show considerable
variation in their design, study population, duration and
type of control. The studies with energy intake as the
outcome measure are summarised in Table 1 while those
with weight loss are summarised in Table 2.
Number of subjects
The largest trial had 163 subjects (Blackburn
et al
.
1997) while the two smallest trials had six and eight
subjects (Porikos
et al
. 1977, 1982). Most trials had
between 10–30 subjects.

118
A. de la Hunty
et al.
© 2006 British Nutrition Foundation
Nutrition Bulletin
,
31
, 115 –128
Ta b le 1
Summary of studies with energy intakes as an outcome measure
Reference
Number of
subjects
Length of
study Intervention
Amount energy
substituted Reduction in energy intake Calculated % compensation
No energy restriction
Evans (1989) 16 post-obese
women
5 occasional
aspartame user s
11 regular users
3 weeks Subjects were asked to exclude all
aspartame-sweetened products from their
diet
Average difference
in baseline energy
intakes was
194 kcal/day
Regular users increased energy intakes by
119 kcal/day
vs
. low users who decreased
energy intakes by 204 kcal/day.
ns
Cannot be calculated
Foltin
et al
. (1992) 6 normal-weight
men
7
×
2 days Subjects in a metabolic ward were given
foods which varied in energy, fat and
carbohydrate content. The rest of their
diet was freely chosen from a range of
foods
Energy content of
required foods
ranged from 700
to 1700 kcal
−
808 kcal/day* on low carbohydrate
vs
. high
carbohydrate
−
480 kcal/day* on low carbohydrate
vs
.
control
*
P
<
0.05
16%
Foltin
et al
. (1990) 6 normal-weight
men
4
×
3 days Subjects in a metabolic ward were given
four different lunches (low fat, low
carbohydrate, high fat and high
carbohydrate). All other food was freely
chosen from a selection
Lunches provided
either 431 or
844 kcal
−
98 kcal/day on low calorie (carbohydrate)
vs
. high calorie (carbohydrate)
ns
76%
Foltin
et al
. (1988) 6 normal-weight
men
2
×
6 days Subjects in a metabolic ward were provided
with a variety of foods which could be
eaten at any time. One-third of foods
were substituted for low-calorie
alternatives
About 500 kcal No significant difference in energy intake
when lower-calorie foods given.
Significant increase in energy intake when
regular-calorie foods reintroduced
100%
Gatenby
et al
.
(1997)
13/17/19 non-
obese women
10 weeks Subjects in the intervention groups were
instructed to use either reduced-fat or
reduced-sugar foods instead of usual
foods
Not reported
−
276 (control)
vs
.
−
293 (reduced fat)
vs.
−
329 kcal/day (reduced sugar)
ns
Cannot be calculated
Lavin
et al
. (1997) 14 women 1 day Subjects were given 4
×
330 ml of drinks
sweetened with either aspartame or
sucrose or carbonated mineral water.
Energy intakes were measured on the day
and the following day. Half the subjects
were told what they were drinking
1.38 MJ
+
1.7 MJ on aspartame compared with
sucrose on the first day
*
P
<
0.05
+
3.7 MJ on aspartame compared with
sucrose over 2 days*
P
<
0.05
111% (over 2 days)
Mattes (1990) 12 men
12 women
5 days Subjects were given breakfast cereals
sweetened with either aspartame or
sucrose or unsweetened. Half the subjects
were aware of the composition
(informed), the others were not (naïve)
Breakfasts were
equicaloric
+
189 kcal/day for informed aspartame group
compared with naïve group
ns
+
224 kcal/day for informed aspartame group
compared with informed sucrose group
ns
110% informed (knew what
the composition was)
103% naïve (did not know
what the composition
was)
*Refers to
P
-value.
**
P
<
0.05.
ns
, non-significant.

Effect of aspartame on weight control
119
© 2006 British Nutrition Foundation
Nutrition Bulletin
,
31
, 115 –128
Naismith and
Rhodes (1995)
10 normal-weight
men
2
×
10 days Subjects were given meals and snacks
sweetened with sucrose then sweeteners
520 kcal
−
260 kcal/day
ns
42%
Por ikos
et al
.
(1982)
6 normal-weight
men
2
×
12 days Subjects in a metabolic ward were given
foods sweetened with either aspartame
or sucrose in a crossover study
About 900 kcal
−
622 kcal/day* on aspartame
vs
. sucrose
*
P
<
0.01
40%
Por ikos
et al
.
(1977)
8 obese adults 6 days on
aspartame
vs
.
9 days on
sucrose diet
Subjects in a metabolic ward were given
foods sweetened with either aspartame
or sucrose in a crossover study
850 and 897 kcal
on two aspartame
periods
−
762 and
−
452 kcal/day* on two aspartame
periods
vs
. sucrose period
*
P
<
0.05
50%
Raben
et al
. (2002) 21/20
overweight men
and women
10 weeks Overweight people were given foods and
drinks sweetened with either sucrose or
intense sweeteners to incorporate into
their daily diet
2.0–2.9 MJ
+
1.6 MJ* (sucrose)
vs
.
−
0.45 MJ/day
(sweetener)
*
P
<
0.05 compared with baseline
18%
Reid and
Hammersley
(1998)
28 normal-weight
men and women
1 week Subjects were given soft drinks sweetened
with either aspartame or sucrose to
incorporate into their daily diet
200–400 kcal Energy intakes less with aspartame drinks
than with sucrose drinks but not
significantly so
Energy difference between
groups similar to
difference in soft drinks
Tordoff and Alleva
(1990)
30 non-obese
men and women
3
×
3 weeks Subjects were given 1150 g of soft drink (
=
4
cans) sweetened with either aspartame or
high-fructose corn syrup (HFCS) or no
soft drink in a crossover study
530 kcal
−
236* (women) and
−
154 kcal/day* (men)
on aspartame
vs
. no soft drinks
+
247* (women) and
+
374 kcal/day* (men)
on HFCS
vs
. no soft drinks
*
P
<
0.05
9% (women) and
1% (men)
Van Wymelbeke
et al. (2004)
12 men and 12
women
4 weeks Subjects drank 2 l of a soft drink sweetened
with either sucrose or intense sweeteners
and energy intake was measured on 2
successive days. This was repeated after
1 month of consuming either drink every
day
3.34 MJ Session 1 – 2.98 MJ over 2 days**
Session 2 – 3.08 MJ over 2 days**
Session 3 – 3.20 MJ over 2 days**
12% session 1
8% session 2
4% session 3
Weight loss diet
Blackburn et al.
(1997)
163 obese
women
16 weeks
+1 year
+2 years
Intervention group were given, in addition to
weight loss diet, aspartame-sweetened
puddings or milkshakes and encouraged
to use other aspartame-sweetened
products
Not reported After 16 weeks
−588 (aspartame) vs. −456 kcal/day (control)
After 1 year
−763 (aspartame) vs. −684 kcal/day (control)
ns
Cannot be calculated
Reference
Number of
subjects
Length of
study Intervention
Amount energy
substituted Reduction in energy intake Calculated % compensation
*Refers to P-value.
**P < 0.05.
ns, non-significant.
Ta b le 1 Continued

120 A. de la Hunty et al.
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115 –128
Ta b le 2 Summary of data of studies with weight as an outcome measure
Reference
Number
of study Length of study Intervention BMI Weight change
No energy restriction
Gatenby et al. (1997) 13/17/19 10 weeks Subjects in the inter vention groups were
instructed to use either reduced-fat or
reduced-sugar foods instead of usual
foods
<30 No significant effect on bodyweight
Naismith and Rhodes
(1995)
10 men 10 days Subjects were provided with a diet from
which about 500 kcal had been either
covertly removed or added by the
substitution of aspartame for sucrose
22.6 and 21.4 +0.13 kg for sucrose then aspartame
+0.44 kg for aspartame then sucrose
ns
Por ikos et al. (1982) 6 men 2 × 12 days Subjects in a metabolic ward were given
foods sweetened with either aspartame
or sucrose in a crossover study
23.4 +0.8* (sucrose) vs. −0.8 kg (aspar tame)
*P < 0.05 compared with baseline
Por ikos et al. (1977) 8 6 days on
aspartame
vs. 9 days on
sucrose diet
Subjects in a metabolic ward were given
foods sweetened with either aspartame
or sucrose in a crossover study
>30 104.3 (sucrose) vs. 104.0 kg (aspartame)
ns
Raben et al. (2002) 21/20 10 weeks Overweight people were given foods and
drinks sweetened with either sucrose or
intense sweeteners to incorporate into
their daily diet
28.0/27.6 +1.6 (sucrose) vs. −1.0 kg* (sweetener)
*P < 0.001 compared with sucrose group
Reid and Hammersley
(1998)
28 1 week Subjects were given soft drinks sweetened
with either aspartame or sucrose to
incorporate into their daily diet
Men 22.5/
25.0
Women 23.4/
23.5
No significant effect on weight
Tordoff and Alleva
(1990)
30 3 × 3 weeks Subjects were given 1150 g of soft drinks (=4
cans) sweetened with either aspartame or
high-fructose corn syrup (HFCS) or no
soft drinks in a crossover study
25.4
(women)
25.1 (men)
+0.25 (women) and −0.47 kg* (men) on
aspartame vs. no soft drinks
+0.97* (women) and +0.52 kg (men) on
HFCS vs. no soft drinks
*P < 0.05
Weight loss diets
Blackburn et al.
(1997)
163 16 weeks
+1 year
+2 years
Intervention group were given, in addition to
weight loss diet, aspar tame-sweetened
puddings or milkshakes and encouraged to
use other aspartame-sweetened products
Aspartame
37.4
Control 37.2
After 16 weeks
−9.9 (aspartame) vs. −9.8 kg (control)
After 1 year
+2.6* (aspartame) vs. +5.4 kg (control)
After 2 more years (net weight loss)
−5.1* (aspartame) vs. 0 kg (control)
*P < 0.05 compared with control
Kanders et al. (1988,
1990)
59 (13
men;
46
women)
12 weeks Inter vention group were given, in addition to
weight loss diet, low-calorie, aspartame-
sweetened puddings or milkshakes and
encouraged to use diet drinks etc
Men 37/38
Women 36/
38
After 12 weeks
Men
−23.0 (intervention) vs. −27.0 lbs (control)
Women
−16.5 (intervention) vs. −12.8 lbs (control)
After 1 year
Inverse association between aspartame
and weight regain in men but not in
women
*Refers to P-value.
BMI, body mass index; ns, non-significant.

Effect of aspartame on weight control 121
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115– 128
Length of trials
The longest trial had an intervention period of
19 weeks, and then followed up subjects for 3 years
(Blackburn et al. 1997) while the shortest trial had an
intervention period of only 1 day (Lavin et al. 1997).
Seven trials had an intervention period less than 1 week
while three trials lasted for 10 or 12 weeks.
Body mass index
Subjects in three of the trials were obese with body mass
index over 30 kg/m2 (Porikos et al. 1977; Kanders et al.
1988; Blackburn et al. 1997). Two of these trials were
weight loss trials where average body mass indices were
around 37 kg/m2. The other trials were in normal-
weight or overweight people.
Energy-restricted diet
Two trials tested the effectiveness of aspartame-contain-
ing products in people on an energy-restricted diet, who
were trying to lose weight (Kanders et al. 1988; Black-
burn et al. 1997). The other trials compared the effect of
substituting foods and drinks containing aspartame/
intense sweeteners for similar foods containing sugar in
an ab libitum diet.
Setting
The studies were carried out in both metabolic ward sit-
uations and in the free-living population. Some of the
studies in metabolic wards allowed subjects to deter-
mine the amount of food they consumed from a platter
of foods offered to them (Porikos et al. 1977, 1982)
while other studies allowed them to select the food they
wanted from a list of available foods (Foltin et al. 1988,
1990, 1992). Studies in free-living populations either
gave subjects daily food supplements (Mattes 1990;
Raben et al. 2002), provided meals on site (Naismith &
Rhodes 1995) or told subjects to replace items in their
diet with reduced sugar versions of their normal foods
(Gatenby et al. 1997).
Intervention vehicle
Four trials used soft drinks only as the vehicle for aspar-
tame substitution. In one trial (Tordoff & Alleva 1990),
subjects were required to drink the equivalent of four
bottles (1135 g/day) of soft drinks each day while in
another (Reid & Hammersley 1998), subjects were
recruited on the basis of habitually drinking at least two
bottles (250 ml each) of soft drinks a day. In the study
by Van Wymelbeke et al. (2004), subjects were required
to drink 2 l of a beverage on the study days while those
in the study by Lavin et al. (1997) were given four cans
(330 ml) of lemonade to drink at defined times during
the day. In a fifth trial (Raben et al. 2002), 80% by
weight of the substituted foods were given as soft drinks
as this reflects the distribution of the population’s intake
of intense sweeteners. The average intake of soft drinks
in this study was 1285 g/day.
The other trials used breakfast cereals (Mattes 1990)
or selections of commercially available foods and drinks
sweetened with aspartame (Porikos et al. 1977, 1982;
Kanders et al. 1988; Blackburn et al. 1997) or a mixture
of intense sweeteners (Foltin et al. 1988, 1990, 1992;
Naismith & Rhodes 1995; Gatenby et al. 1997; Raben
et al. 2002).
Amount of food or energy substituted
This information was not always reported, nor was it
reported in a similar way in each study. Some studies
reported the amount of food that had been sub-
stituted while others reported the amount of sucrose
or the percentage of energy substituted by aspartame
products.
The studies which used soft drinks as the vehicle for
aspartame used between 500 and about 2000 ml which
is equivalent to about two to six cans or bottles of
soft drinks every day. One study reported that about
2000 g of food per day was substituted for aspartame-
containing foods (Porikos et al. 1977) while another
reported that about 25% of energy was substituted
(Porikos et al. 1982). The amount of energy substituted
by aspartame ranged from about 200 kcal/day
(0.84 MJ) (Reid & Hammersley 1998) to about
1000 kcal/day (4.2 MJ) (Foltin et al. 1992).
Controls
The choice of control has an important effect on the out-
come of the study and the relevance of the control diet
to the ‘normal’ diet is open to question in many of the
studies. For a number of studies, the control diet
involved the addition of a large amount of sucrose-
containing foods which did not reflect the subjects’
previous diets and on which subjects gained weight
(Porikos et al. 1977, 1982).
Whether the control period was before or after the
aspartame period also has an effect on the outcome. Ten
studies had a parallel sucrose-containing control while
five studies compared aspartame with sucrose before
and/or after (Porikos et al. 1977, 1982; Foltin et al.

122 A. de la Hunty et al.
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115 –128
1988; Evans 1989; Naismith & Rhodes 1995). Three
studies also had an additional control of carbonated
mineral water (Lavin et al. 1997), plain cereal (Mattes
1990) or no soda (Tordoff & Alleva 1990). In a number
of studies, comparisons were also made with baseline
values (Mattes 1990; Foltin et al. 1992; Raben et al.
2002).
Results of meta-analysis
Energy intakes
The 15 studies with energy intake as an outcome mea-
sure were subjected to a meta-analysis to calculate the
combined effect (expressed as the standardised differ-
ence or SD) of all the studies together (Fig. 1). Effect
sizes for each study were computed from the sample
sizes, and either group means and standard deviation or
P-values. Data presentation lacked statistical detail in a
few studies, requiring standard deviations to be calcu-
lated or imputed. Studies varied in their design, subjects
and types of control, so we used a random effects model
(which allows that the true effect might differ from
study to study) rather than a fixed effect model (which
assumes that the true effect is the same for all studies).
Hedges’ adjustment was used, which gave a more con-
servative estimate of effect size. The plots illustrate the
size and direction of effect for each study and the overall
effect of all studies combined, with 95% (lower and
upper) confidence intervals. All analyses were per-
formed using the software package Comprehensive
Meta-analysis (Biostat Inc., Englewood, NJ, USA). The
studies were analysed according to the type of controls
as this affected the results. The different controls were
baseline diet, parallel sucrose control, non-sucrose con-
trol (e.g. water) or the reintroduction of sucrose. The
effect of substituting aspartame-sweetened drinks with
each of these controls is shown in Table 3.
A significant reduction in energy intakes was seen
with aspartame compared with all types of control
except when aspartame was compared with non-sucrose
controls such as water.
The most relevant comparisons are the parallel design
studies which compare the effects of aspartame with
sucrose. These had an overall effect size of 0.4 SD. As
the coefficient of variation of energy intake is around
25%, this corresponds to a mean reduction of about
10% of energy intake. At an average energy intake of
9.3 MJ/day (average of adult men and women aged 19–
50 years) this is a deficit of 0.93 MJ/day (222 kcal/day
or 1560 kcal/week), which would be predicted (using an
energy value for obese tissue of 7500 kcal/kg) to result
in a weight loss of around 0.2 kg/week with a confi-
dence interval 50% either side of this estimate.
The strongest effect was found for comparisons in
which the aspartame/low-sugar period was followed by
a normal/high-sucrose diet (effect size > 1 SD). This
suggests that increases in energy intake are less well
compensated than decreases in energy intake.
Average level of compensation
Compensation is the explanation for the difference
between the theoretical energy intake and the actual
energy intake in any study. The extent of compensation
that occurred in the different studies was not reported
for all studies, although it could be calculated for some
studies from information given in the paper. Informa-
tion on the extent of compensation was available for 12
of the 15 studies. The weighted average of these figures
was 32% although they ranged from 1% to 111% (see
Table 1). This estimate agrees well with the value of
36% for solid food calculated by Mattes (1996) in a
meta-analysis of 42 studies.
Compensation is likely to vary with a number of fac-
tors such as the size of the caloric deficit, the type of
food or drink manipulated, and timescale. An estimate
of the amount of compensation with soft drinks was cal-
culated from the four studies which used soft drinks
only as the vehicle (Tordoff & Alleva 1990; Lavin et al.
1997; Reid & Hammersley 1998; Van Wymelbeke et al.
2004). A weighted average of these figures was 15.5%.
This agrees with suggestions by other authors that com-
pensation is likely to be less where the substitution vehi-
cle is a liquid. This is because energy obtained from
liquids is less satisfying than energy from solid foods,
making it easier to overconsume energy when drinking
liquids than when eating solids (Beridot-Therond et al.
1998; Van Wymelbeke et al. 2004).
Ta b le 3 Summary of meta-analysis of energy intake
Type of control (number
of study outcomes) P-value Effect (SD)
95% confidence
limits
Lower Upper
Baseline (8) 0.017 0.58 0.10 1.05
Non-sucrose control (7) 0.377 0.18 −0.22 0.58
Sucrose after (5) 0.000 1.14 0.52 1.76
Sucrose parallel (12) 0.033 0.40 0.03 0.77
All studies (32) 0.000 0.47 0.24 0.70
SD, standardised difference.

Effect of aspartame on weight control 123
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115– 128
Figure 1 Meta-analysis of studies of energy reduction with sweetener vs. other regime (subgroup analysis). CI, confidence intervals; SD, standardised difference.
Effect Confidence Study
Comparison group Significance size limits (95%) Mean effect and 95% CI duration
(number of studies) Study authors of effect (SD) of effect (units are SDs) (weeks)
P-Value Lower Upper -4.00 -2.00 0.00 2.00 4.00
Base Foltin et al., 1988 1.000 0.000 −1.286 1.286 <1
Base Foltin et al., 1992 0.027 1.380 −0.117 2.877 <1
Base Porikos et al., 1982 0.010 1.689 0.097 3.281 1
Base Porikos et al., 1977 0.010 1.407 0.171 2.634 1
Base Mattes, 1990 0.795 0.104 −0.744 0.951 <1
Base Mattes, 1990 0.736 −0.135 −0.982 0.713 <1
Base Naismith & Rhodes, 0.020 1.093 0.070 2.116 2
1995
Base Raben et al., 2002 0.534 0.194 −0.447 0.836 10
Fixed Base (8) 0.006 0.467 0.139 0.795
Random Base (8) 0.017 0.578 0.103 1.053
Other Mattes, 1990 0.516 −0.260 −1.111 0.591 <1
Other Mattes, 1990 0.614 0.202 −0.648 1.051 <1
Other Lavin et al., 1997 0.050 −0.754 −1.563 0.054 <1
Other Tordoff & Alleva, 1990 0.050 0.952 −0.118 2.021 3
Other Tordoff & Alleva, 1990 0.050 0.612 −0.028 1.252 3
Other Tordoff & Alleva, 1990 0.379 0.406 −0.606 1.418 3
Other Tordoff & Alleva, 1990 0.476 0.218 −0.408 0.843 3
Fixed Other (7) 0.207 0.184 -0.103 0.472
Random Other (7) 0.377 0.180 -0.221 0.581
Sucrose after Porikos et al., 1977 0.010 1.689 0.097 3.281 1
Sucrose after Porikos et al., 1982 0.010 1.689 0.097 3.281 1
Sucrose after Foltin et al., 1988 0.020 1.473 −0.051 2.997 <1
Sucrose after Naismith & Rhodes, 0.050 1.505 −0.655 3.664 2
1995
Sucrose after Evans, 1989 0.364 0.381 −0.518 1.281 3
Fixed Sucrose after (5) 0.000 1.081 0.521 1.641
Random Sucrose after (5) 0.000 1.137 0.518 1.755
Sucrose parallel Van Wymelbeke et al., 0.001 0.998 0.379 1.617 <1
2004
Sucrose parallel Mattes, 1990 0.660 −0.176 −1.024 0.673 <1
Sucrose parallel Mattes, 1990 0.090 −0.699 −1.576 0.178 <1
Sucrose parallel Lavin et al., 1997 0.010 −1.020 −1.853 −0.186 <1
Sucrose parallel Foltin et al., 1992 0.016 1.542 −0.003 3.087 <1
Sucrose parallel Foltin et al., 1990 0.758 0.169 −1.121 1.458 <1
Sucrose parallel Reid & Hammersley, 0.217 0.473 −0.333 1.280 1
1998
Sucrose parallel Tordoff & Alleva, 1990 0.011 0.812 0.161 1.463 3
Sucrose parallel Tordoff & Alleva, 1990 0.057 0.923 −0.142 1.988 3
Sucrose parallel Gatenby et al., 1997 0.137 0.536 −0.213 1.286 10
Sucrose parallel Raben et al., 2002 0.002 1.015 0.340 1.690 10
Sucrose parallel Blackburn et al., 1997 0.015 0.435 0.081 0.789 19
Fixed Sucrose parallel (12) 0.000 0.439 0.243 0.634
Random Sucrose parallel (12) 0.033 0.403 0.034 0.773
Fixed Combined (32) 0.000 0.425 0.285 0.564
Random Combined (32) 0.000 0.470 0.244 0.696
Increase Decrease

124 A. de la Hunty et al.
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115 –128
Weight loss
A meta-analysis of the 9 studies with weight loss as an
outcome measure was also conducted to calculate the
combined effect of aspartame on weight loss. The anal-
ysis was conducted in three stages. The first stage used
all weight outcomes including follow-up weights, the
second excluded studies in which the control group
gained weight and the third excluded follow-up periods
as well. Forrest plots for these analyses are shown in
Figures 2–4. The combined effects of the results for the
different analyses are shown in Table 4.
A significant reduction in weight was seen for all three
analyses. The final combined effect figure of 0.221 SD
(from Fig. 4) is a conservative figure as it excludes com-
parisons where the controls gained weight because of
their high-sucrose diet and the long-term follow-up data
in which the aspartame groups regained less weight than
the control group. This gave the appearance of an
increasing weight loss with aspartame.
As the coefficient of variation for bodyweight calcu-
lated from the larger studies was 15%, an effect of
0.2 SD corresponds to about a 3% reduction in body-
weight (2.3 kg for an adult weighing 75 kg). Given the
Figure 2 Meta-analysis of studies of weight loss with sweetener vs. sucrose regime (all studies). CI, confidence intervals; SD, standardised difference.
Effect Confidence Study
C
omparison group Study Significance size limits (95%) Mean effect and 95% CI duration
(
number of studies) authors of effect (SD) of effect (units are SDs) (weeks)
P-Value Lower Upper -4.00 -2.00 0.00 2.00 4.00
Base Porikos et al., 1982 0.100 0.966 −0.428 2.360 1
Base Porikos et al., 1977 0.981 0.011 −1.061 1.084 1
Base Naismith & Rhodes, 0.710 −0.162 −1.103 0.780 2
1995
Base Raben et al., 2002 0.087 0.545 −0.109 1.198 10
Fixed Base (4) 0.135 0.328 -0.104 0.761
Random Base (4) 0.144 0.326 -0.114 0.767
Other Tordoff & Alleva, 1990 0.564 −0.265 −1.269 0.740 3
Other Tordoff & Alleva, 1990 0.050 0.612 −0.028 1.252 3
Fixed Other (2) 0.199 0.342 -0.185 0.869
Random Other (2) 0.574 0.245 -0.621 1.110
Sucrose after Porikos et al., 1982 0.050 0.817 −0.070 1.705
Sucrose after Porikos et al., 1977 0.050 1.014 −0.146 2.174 1
Sucrose after Naismith & Rhodes, 0.135 1.063 −0.893 3.019 2
1995
Fixed Sucrose after (3) 0.005 0.919 0.295 1.542
Random Sucrose after (3) 0.005 0.919 0.295 1.542
Sucrose parallel Reid & Hammersley, 1.000 0.000 −0.793 0.793 1
1998
Sucrose parallel Tordoff & Alleva, 1990 0.010 1.310 0.182 2.439 3
Sucrose parallel Tordoff & Alleva, 1990 0.116 0.486 −0.148 1.120 3
Sucrose parallel Raben et al., 2002 0.001 1.090 0.408 1.772 10
Sucrose parallel Gatenby et al., 1997 0.175 0.487 −0.260 1.234 10
Sucrose parallel Kanders et al., 1988 0.102 0.490 −0.122 1.102 12
Sucrose parallel Kanders et al., 1988 0.623 −0.292 −1.721 1.137 12
Sucrose parallel Blackburn et al., 1997 0.919 0.016 −0.294 0.325 19
Sucrose parallel Kanders et al., 1990 0.040 0.613 0.004 1.223 52
Sucrose parallel Blackburn et al., 1997 0.143 0.318 −0.117 0.752 71
Sucrose parallel Blackburn et al., 1997 0.028 0.487 0.043 0.930 175
Fixed Sucrose parallel (11) 0.000 0.358 0.194 0.523
Random Sucrose parallel (11) 0.000 0.420 0.194 0.645
Fixed Combined (20) 0.000 0.385 0.242 0.528
Random Combined (20) 0.000 0.426 0.251 0.601
Increase Decrease

Effect of aspartame on weight control 125
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115– 128
Figure 3 Meta-analysis of studies of weight loss with sweetener (excluding outcomes with weight gain on sucrose regime). CI, confidence intervals; SD,
standardised difference.
Effect Confidence Study
Study Significance size limits (95%) of duration Mean effect and 95% CI
authors of effect (SD) effect (weeks) (units are SDs) Type of control
P-Value Lower Upper -4.00 -2.00 0.00 2.00 4.00
Reid & Hammersley, 1998 1.000 0.000 −0.793 0.793 1 Sucrose parallel
Tordoff & Alleva, 1990 0.564 −0.265 −1.269 0.740 3 Other
Tordoff & Alleva, 1990 0.050 0.612 −0.028 1.252 3 Other
Raben et al., 2002 0.087 0.545 −0.109 1.198 10 Base
Gatenby et al., 1997 0.175 0.487 −0.260 1.234 10 Sucrose parallel
Kanders et al., 1988 0.102 0.490 −0.122 1.102 12 Sucrose parallel
Kanders et al., 1988 0.623 −0.292 −1.721 1.137 12 Sucrose parallel
Blackburn et al., 1997 0.919 0.016 −0.294 0.325 19 Sucrose parallel
Kanders et al.,1990 0.040 0.613 0.004 1.223 52 Sucrose parallel
Blackburn et al., 1997 0.143 0.318 −0.117 0.752 71 Sucrose parallel
Blackburn et al., 1997 0.028 0.487 0.043 0.930 175 Sucrose parallel
Fixed Combined (11) 0.000 0.292 0.129 0.456
Random Combined (11) 0.001 0.295 0.129 0.460
Increase Decrease
Figure 4 Meta-analysis of studies of weight loss (intervention period only, excluding studies with weight gain on sucrose regime). CI, confidence intervals; SD,
standardised difference.
Effect Confidence Study
Study Significance size limits (95%) of duration Mean effect and 95% CI
authors of effect (SD) effect (weeks) (units are SDs) Type of control
P-Value Lower Upper -4.00 -2.00 0.00 2.00 4.00
Reid & Hammersley, 1998 1.000 0.000 −0.793 0.793 1 Sucrose parallel
Tordoff & Alleva, 1990 0.564 −0.265 −1.269 0.740 3 Other
Tordoff & Alleva, 1990 0.050 0.612 −0.028 1.252 3 Other
Raben et al., 2002 0.087 0.545 −0.109 1.198 10 Base
Gatenby et al., 1997 0.175 0.487 −0.260 1.234 10 Sucrose parallel
Kanders et al., 1988 0.102 0.490 −0.122 1.102 12 Sucrose parallel
Kanders et al., 1988 0.623 −0.292 −1.721 1.137 12 Sucrose parallel
Blackburn et al., 1997 0.919 0.016 −0.294 0.325 19 Sucrose parallel
Fixed Combined (8) 0.048 0.206 0.001 0.411
Random Combined (8) 0.050 0.221 0.000 0.443
Increase Decrease
Ta b le 4 Summary of meta-analysis of weight loss: effect size (as SD) by type of study
Studies (number of study outcomes) P-value Effect (SD)
95% confidence limits
Lower Upper
All studies of weight loss (20) 0.0000 0.385 0.242 0.528
Excluding those with a weight-gaining control (11) 0.001 0.295 0.129 0.460
Excluding weight-gaining controls and follow-up data (8) 0.050 0.221 0.000 0.443
SD, standardised difference.

126 A. de la Hunty et al.
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115 –128
weighted average study length was 12 weeks, this gives
an estimated rate of weight loss of around 0.2 kg/week
for a 75 kg adult.
Weight maintenance
The two weight loss studies followed participants up for
1 year (Kanders et al. 1990) and 3 years (Blackburn
et al. 1997) after the initial weight loss phase of the
study. In the Kanders et al. study, weight maintenance
was better in men who consumed more aspartame prod-
ucts over the follow-up period but there was no differ-
ence for women. The Blackburn et al. study found that
weight regain was significantly less in those consuming
aspartame-sweetened products than in those who were
not. After 3 years, those who consumed aspartame
products had maintained a weight loss of 5.1 kg com-
pared with those in the no-aspartame group who had
regained all their previous weight loss.
Conclusions
The meta-analyses demonstrate that using foods and
drinks sweetened with aspartame instead of sucrose
results in a significant reduction in both energy intakes
and bodyweight. The meta-analyses both of energy
intake and of weight loss produced an estimated rate of
weight loss of about 0.2 kg/week. This close agreement
between the figure calculated from reductions in energy
intake and actual measures of weight loss gives confi-
dence that this is a true effect. The two meta-analyses
used different sets of studies with widely differing
designs and controls. Although this makes comparisons
between them difficult, it suggests that the final figure of
around 0.2 kg/week is robust and is applicable to the
variety of ways aspartame-containing foods are used by
consumers. This is a low but meaningful rate of weight
loss and, on a population basis, more than sufficient to
counteract the current average rate of weight gain of
around 0.007 kg/week (NHS Health and Social Care
Information Centre 2005). On an individual basis, it
provides a useful adjunct to other weight loss regimes.
Unconscious compensation
An estimated compensation rate of around one-third of
energy substituted was calculated from the studies
which provided sufficient information. However, basing
the calculations only on studies which used soft drinks
as the substitution vehicle gave a lower figure of about
half this, i.e. around 15%. This is reasonable as it is
likely that energy obtained from liquids is less satiating
than that obtained from foods and so the body is less
likely to adjust for the energy contained in a sucrose-
containing drink than it would if the same amount of
energy was provided in a solid food. Nevertheless, these
compensation values are derived from short-term stud-
ies. More data are needed over the longer term to deter-
mine whether a tolerance to the effects is acquired.
Conscious adjustment
In addition to an unconscious compensatory effect, the
effects of the conscious adjustments and trade-offs that
people consuming low-calorie foods make also need to
be considered. Most of the studies included in the meta-
analysis were blind and people did not know whether
they were consuming the sugar or the aspartame-
containing version. Therefore, these studies are not able
to address this question.
Nevertheless, one study was not blind (Gatenby et al.
1997) and two studies included an unblind comparison
(Mattes 1990; Lavin et al. 1997). In the Gatenby et al.
study, subjects consuming the low-sugar versions had a
non-significantly lower energy intake than those con-
suming the normal versions; however, some subjects
increased their energy intake suggesting that there was
an element of adjustment. In the Mattes study, both
groups increased their energy intakes (non-significantly)
compared with the sucrose controls but those who were
aware they had consumed a low-calorie cereal did so
more than those who were unaware. In the Lavin et al.
study, both informed and uninformed groups compen-
sated for the low-calorie drink (Lavin et al. 1997).
During the follow-up period of the Blackburn et al.
trial, subjects were encouraged to continue using or not
using aspartame-sweetened products according to what
they had been doing during the intervention period.
Over the next 3 years, those who used the aspartame-
sweetened foods regained significantly less weight than
those who did not (Blackburn et al. 1997).
Therefore, although the effect of conscious adjust-
ment might mitigate against the expected reduction in
energy intakes with casual aspartame use, it is likely to
be less important for people determinedly trying to con-
trol their weight.
Effectiveness of aspartame for weight loss
This review has shown that using foods and drinks
sweetened with aspartame instead of those sweetened
with sucrose is an effective way to maintain and lose
weight without losing the palatability of the diet. The
decrease in energy intakes and the rate of weight loss

Effect of aspartame on weight control 127
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115– 128
that can reasonably be achieved is low but meaningful.
Some compensation for the substituted energy does
occur but this is only about one-third of the energy
replaced and is probably less when using soft drinks
sweetened with aspartame. Nevertheless, these compen-
sation values are derived from short-term studies. More
data are needed over the longer term to determine
whether a tolerance to the effects is acquired.
To achieve the average rate of weight loss seen in
these studies of 0.2 kg/week will require around a 220-
kcal deficit (0.93 MJ) per day using an energy value for
obese tissue of 7500 kcal/kg. Assuming the higher rate
of compensation (32%), this would require the substi-
tution of around 330 kcal/day (1.4 MJ/day) from
sucrose with aspartame (which is equivalent to around
88 g of sucrose). Using the lower estimated rate of com-
pensation for soft drinks alone (15.5%) would require
the substitution of about 260 kcal/day (1.1 MJ/day)
from sucrose with aspartame. This is equivalent to 70 g
of sucrose or about two cans of soft drinks every day.
Acknowledgements
The authors wish to thank the Ajinomoto Company for
financial support.
References
Benton D (2005) Can artificial sweeteners help control body
weight and prevent obesity? Nutrition Research Reviews 18:
63–76.
Beridot-Therond ME, Arts I, Fantino M et al. (1998) Short-term
effects of the flavour of drinks on ingestive behaviours in man.
Appetite 31: 67–81.
Blackburn GL, Kanders BS, Lavin PT et al. (1997) The effect of aspar-
tame as part of a multidisciplinary weight-control program on
short- and long-term control of body weight. American Journal of
Clinical Nutrition 65: 409–18.
Blundell JE & Hill AJ (1986) Paradoxical effects of an intense sweet-
ener (aspartame) on appetite. Lancet 1: 1092–3.
Drewnowski A (1999) Intense sweeteners and energy density of foods:
implications for weight control. European Journal of Clinical
Nutrition 53: 757–63.
Evans E (1989) Effect of withdrawal of artificial sweeteners on energy
intake of stabilized post-obese women. International Journal of
Obesity 13 (Suppl. 1): 111.
Foltin RW, Fischman MW, Emurian CS et al. (1988) Compensation
for caloric dilution in humans given unrestricted access to food in a
residential laboratory. Appetite 10: 13–24.
Foltin RW, Fischman MW, Moran TH et al. (1990) Caloric compen-
sation for lunches varying in fat and carbohydrate content by
humans in a residential laboratory. American Journal of Clinical
Nutrition 52: 969–80.
Foltin RW, Rolls BJ, Moran TH et al. (1992) Caloric, but not macro-
nutrient, compensation by humans for required-eating occasions
with meals and snack varying in fat and carbohydrate. American
Journal of Clinical Nutrition 55: 331–42.
Gatenby SJ, Aaron JI, Jack VA et al. (1997) Extended use of foods
modified in fat and sugar content: nutritional implications in a free-
living female population. American Journal of Clinical Nutrition
65: 1867–73.
Health Select Committee (2004) Third Report: Obesity. H. O. Com-
mons: London.
Kanders BS, Lavin JH, Kowalchuk MB et al. (1990) Do aspartame
(APM)-sweetened foods and beverages in the long-term aid in long-
term control of body weight? American Journal of Clinical Nutri-
tion 51: 515 (abstract).
Kanders BS, Blackburn GL, Lavin PT et al. (1996) Evaluation of
weight control. In: The Clinical Evaluation of a Food Additive:
Assessment of Aspartame (C Tschanz, HH Butchko, WW Stargel,
FM Kotsonsis eds), pp. 289–99. CRC Press: Boca Raton, FL.
Kanders BS, Lavin PT, Kowalchuk MB et al. (1988) An evaluation of
the effect of aspartame on weight loss. Appetite 11 (Suppl. 1): 73–
84.
Lavin JH, French SJ & Read NW (1997) The effect of sucrose- and
aspartame-sweetened drinks on energy intake, hunger and food
choice of female, moderately restrained eaters. International Jour-
nal of Obesity and Related Metabolic Disorders 21: 37–42.
Mattes R (1990) Effects of aspartame and sucrose on hunger and
energy intake in humans. Physiology and Behavior 47: 1037–44.
Mattes RD (1996) Dietary compensation by humans for supplemental
energy provided as ethanol or carbohydrate in fluids. Physiology
and Behavior 59: 179–87.
Naismith D & Rhodes C (1995) Adjustment in energy intake follow-
ing the covert removal of sugar from the diet. Journal of Human
Nutrition and Dietetics 8: 167–75.
NHS Health and Social Care Information Centre (2005) Health Sur-
vey for England 2004 – Updating of Trend Data to Include 2004
Data. NHS. Available at: http://www.ic.nhs.uk/pubs/
hlthsvyeng2004upd.
Porikos KP, Booth G & Van Itallie TB (1977) Effect of covert
nutritive dilution on the spontaneous food intake of obese individ-
uals: a pilot study. American Journal of Clinical Nutrition 30:
1638–44.
Porikos KP, Hesser MF & van Itallie TB (1982) Caloric regulation in
normal-weight men maintained on a palatable diet of conventional
foods. Physiology and Behavior 29: 293–300.
Raben A, Vasilaras TH, Moller AC et al. (2002) Sucrose compared
with artificial sweeteners: different effects on ad libitum food intake
and body weight after 10 wk of supplementation in overweight sub-
jects. American Journal of Clinical Nutrition 76: 721–9.
Reid M & Hammersley R (1998) The effects of blind substitution of
aspartame-sweetened for sugar-sweetened soft drinks on appetite
and mood. British Food Journal 100: 254–9.
Rolls BJ & Shide DJ (1996) Evaluation of hunger, food intake and
body weight. In: The Clinical Evaluation of a Food Additive:
Assessment of Aspartame. (C Tschanz, HH Butchko, WW Stargel,
FM Kotsonsis eds), pp. 275–87. CRC Press: Boca Raton, FL.
Tordoff MG & Alleva AM (1990) Effect of drinking soda
sweetened with aspartame or high-fructose corn syrup on food
intake and body weight. American Journal of Clinical Nutrition 51:
963–9.
Van Wymelbeke V, Beridot-Therond ME, de La Gueronniere V et al.
(2004) Influence of repeated consumption of beverages containing

128 A. de la Hunty et al.
© 2006 British Nutrition Foundation Nutrition Bulletin, 31, 115 –128
sucrose or intense sweeteners on food intake. European Journal of
Clinical Nutrition 58: 154–61.
Vermunt SH, Pasman WJ, Schaafsma G et al. (2003) Effects of sugar
intake on body weight: a review. Obesity Review 4: 91–9.
WHO (World Health Organization) (1998) Obesity: Preventing and
Managing the Global Epidemic. Report of WHO Consultation on
Obesity. WHO: Geneva.