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Introduction: Water intake has been proposed for weight loss; however, the evidence of its efficacy is limited. The aim of this study was to systematically review the randomized clinical trials that assessed the effect of water consumption on weight with a follow up ≥ 12 weeks. A systematic query-based search was performed on PubMed, EBSCO, and Cochrane Library to identify eligible records that quantitatively measured body weight change after interventions. This review included six RCTs that reported different strategies for weight loss achievement: increasing daily water intake, replacement of caloric beverages with water, and premeal waterload. All the studies showed a weight loss effect after follow-up, ranged from -0.4 kg to -8.8 kg with a mean percentage of weight loss of 5.15%. The most effective intervention among the studies was the replacement of caloric beverages with water. The quality of the evidence for the primary outcome of weight loss was rated low to moderate. The main limitation of these results is the short-term follow up-period. In conclusion, despite 5.15% of weight loss, the low to moderate quality of evidence and the short term of follow-up are limitations to support evidence-based recommendations of water consumption for weight loss.
ISSN (electrónico): 1699-5198 - ISSN (papel): 0212-1611 - CODEN NUHOEQ S.V.R. 318
Effect of water consumption on weight loss: a systematic review
Efecto del consumo de agua sobre la pérdida de peso: revisión sistemática
Guillermo Bracamontes Castelo, Montserrat Bacardí Gascón and Arturo Jiménez Cruz
Facultad de Medicina y Psicología. Universidad Autónoma de Baja California. Tijuana, Baja California. Mexico
Key words:
Water consumption.
Weight loss. Non-
nutritive sweeteners.
Obesity. Systematic
Water intake has been proposed for weight loss; however, the evidence of its efficacy is limited. The aim of this study was to systematically review
the randomized clinical trials that assessed the effect of water consumption on weight with a follow up ≥ 12 weeks. A systematic query-based
search was performed on PubMed, EBSCO, and Cochrane Library to identify eligible records that quantitatively measured body weight change
after interventions. This review included six RCTs that reported different strategies for weight loss achievement: increasing daily water intake,
replacement of caloric beverages with water, and premeal waterload. All the studies showed a weight loss effect after follow-up, ranged from
-0.4 kg to -8.8 kg with a mean percentage of weight loss of 5.15%. The most effective intervention among the studies was the replacement of
caloric beverages with water. The quality of the evidence for the primary outcome of weight loss was rated low to moderate. The main limitation
of these results is the short-term follow up-period. In conclusion, despite 5.15% of weight loss, the low to moderate quality of evidence and the
short term of follow-up are limitations to support evidence-based recommendations of water consumption for weight loss.
Palabras clave:
Consumo de agua.
Pérdida de peso.
Endulzantes no
nutritivos. Obesidad.
Revisión sistemática.
El consumo de agua se ha propuesto como medida para la pérdida de peso; sin embargo, la evidencia de su eficacia es limitada. El objetivo de
este estudio fue revisar sistemáticamente los ensayos clínicos aleatorizados que han evaluado el efecto del consumo de agua en el peso corporal
con un periodo de seguimiento ≥ 12 semanas. Se realizó una búsqueda sistemática en cadena en PubMed, EBSCO y Cochrane Library para
identificar estudios elegibles que midieran cuantitativamente el cambio de peso corporal después de sus intervenciones. Esta revisión incluye seis
ECA que reportan diferentes estrategias para alcanzar la pérdida de peso: incremento del consumo diario de agua, reemplazo de bebidas calóricas
por agua y sobrecarga con agua previa a las comidas. Todos los estudios mostraron un efecto de pérdida de peso después del seguimiento, con
un rango de -0.4 kg a -8.8 kg y con un porcentaje promedio de pérdida de peso del 5.15%. La intervención más efectiva entre los estudios fue
el reemplazo de bebidas calóricas por agua. La calidad de la evidencia para el resultado primario de pérdida de peso fue calificada de baja a
moderada. La principal limitación de estos resultados es el corto periodo de seguimiento. En conclusión, a pesar de encontrarse unapérdida de
peso del 5.15%, la calidad de la evidencia baja a moderada y el corto periodo de seguimiento son limitaciones para sustentar una recomendación
basada en la evidencia sobre el consumo de agua para la pérdida de peso.
Arturo Jiménez Cruz. Facultad de Medicina y
Psicología. Facultad de Medicina y Psicología.
Tijuana, Baja California. Mexico
Bracamontes Castelo G, Bacardí Gascón M, Jiménez Cruz A. Effect of water consumption on weight loss:
a systematic review. Nutr Hosp 2019;36(6):1424-1429
Received: 19/06/2019 • Accepted: 16/09/2019
©Copyright 2019 SENPE y ©Arán Ediciones S.L. Este es un artículo Open Access bajo la licencia CC BY-NC-SA (
[Nutr Hosp 2019;36(6):1424-1429]
Over the past 50 years, the prevalence of obesity has increased
to pandemic proportions all over the world (1), representing an
important global health and economic problem (2). It was also
considered, between 1975 and 2014, the most common nutri-
tional disorder in the United States (2). The worldwide prevalence
of obesity (BMI ≥ 30 kg/m²) increased from 3.2% in 1974 to
10.8% in 2014 among adult men, and from 6.4% to 14.9% in
adult women over the same period (1,3).
Excess weight has been reported to be associated with various
negative effects such as cardiovascular disease, hypertension,
diabetes, cancer, and chronic renal disease, among others, and
also with early mortality (2,4).
In response to the growing epidemic of obesity and obesity-relat-
ed chronic diseases, over the last four years numerous guidelines
and position statements have been published (5). Some authors
have indicated that the fundamental goal in the treatment of over-
weight and obesity is weight loss, indicated to individuals with BMI ≥
30 or ≥ 27 kg/m2 in the presence of weight-related comorbidity (6).
Evidence-based treatments for weight loss include lifestyle in-
tervention, pharmacotherapy, and bariatric surgery (6). However,
there are inconsistent results regarding the effectiveness of some
of these strategies (lifestyle intervention, pharmacotherapy) in the
long-term maintenance of weight (7-8).
Water is essential for life (9). It comprises about 60% of human
body weight and is critical for life; without water, humans can sur-
vive for just 2-4 days (10). Beverage consumption recommenda-
tions, motivated by the large increase in unhealthy weight patterns
in the United States over the past 20 years, suggest water as the
gold-standard beverage for optimal health (11).
Increasing water intake has been proposed as an important tool
for reducing weight. However, the evidence of its efficacy is limited
(12-13). Epidemiologic and clinical studies suggest that energy
intake is significantly lower in water drinkers than in non-water
drinkers, which may contribute to weight loss and consequently
to obesity prevention (14-18).
Drinking water has been proposed to increase energy expen-
diture and rates of lipolysis (19-21). Some studies have conclud-
ed that drinking water, compared to intake of caloric beverages,
lowers total energy intake (22-25). Absolute increases in drinking
water may promote weight loss by altering metabolism and by a
slight increase in satiety, thus promoting weight loss. Very few
studies have been conducted to assess the long-term effects of
drinking water on changes in body weight (13, 26).
A previous systematic review that analyzed the effect of water
intake on body weight outcomes in an adult population, pub-
lished in 2013, concluded that studies of individuals dieting for
weight loss or maintenance suggest a weight-reducing effect
of increased water consumption, whereas studies in general
mixed-weight populations yielded inconsistent results (27).
However, the weight loss effect was marked as low evidence
because the quality of the studies was poor. In addition, the
review included only one randomized clinical trial with a follow
up of 12 weeks, one non-randomized trial, and a few more with
observational periods of a few days, several of them cross-sec-
tional in design.
Therefore, the aim of this review was to systematically sum-
marize all the existing evidence from randomized clinical trials
that evaluated the effect of water consumption on weight or body
mass index in adult and adolescent populations with a follow-up
equal or greater than 12 weeks.
Figure 1.
Flow diagram of selected studies.
Records identified through database
searching (n = 2966)
MEDLINE (PubMed) (n = 2537)
EBSCO (n = 334)
Cochrane Library (n = 95)
Additional records identified
through othersources (n = 48)
Records duplicates removed (n = 1745)
Records screened (n = 1745)
Full-text articles assesed for
eligibility (n = 18)
Records excluded by title and abstract (n = 1727)
Full-text articles excluded
(n = 12). Reasons:
- Mean follow up < 12 weeks (n = 7)
- Duplicated patients in other included studies (n = 2)
- Unsuitable outcomes (n = 3)
Studies included in qualitative
synthesis (n = 6)
1426 G. Bracamontes Castelo et al.
[Nutr Hosp 2019;36(6):1424-1429]
This systematic review was conducted following the PRISMA
A systematic query-based PubMed search was performed to iden-
tify eligible records that quantitatively measured body weight change
after interventions regarding water consumption. The search terms
used were the following: (“water consumption OR “water intake” OR
“drinking water” OR “beverages” OR “plain water”) AND (“adults” OR
“adolescents”) AND (“body weight” OR “body mass index” OR “weight
loss” OR “weight outcomes” OR “obesity” OR “overweight”).
Searches using the keywords “water intake,” “obesity,” and
“weight loss” were performed in EBSCO, Web of Science, and
Google Scholar to identify additional publications. To maximize
the number of studies assessing body composition outcomes, we
included all studies found in the literature that met the inclusion
criteria. The last search was conducted on March 8th, 2019.
The article selection process is presented in a flow diagram
in figure 1.
Randomized clinical trials of the effects of water consumption on
body weight were selected, including the following criteria: 1. Any
language full-text articles, adolescent and adult population above
12 years old; 2. Articles with a follow-up of at least 12weeks; 3.
Retention rate of at least 70%; 4. Studies that reported baseline
and post-intervention measurements of body weight or BMI or both;
and 5. Studies that reported the amount of water intake. Studies at-
tending populations with comorbidities were included if these were
related to overweight and obesity. We excluded published letters,
comments, reviews, abstracts only, and duplicated studies.
We identified 2,966 articles through the initial database research.
Title screening was performed by one researcher to exclude clear-
ly irrelevant and duplicated studies; 1,221 records were excluded.
Screening on abstract was performed by three researchers, who ex-
cluded 1,727 records. Full-text screening of the remaining 18 records
was initially performed by one researcher, and any eligible records
with uncertain data were discussed with a second researcher. In total,
12 records were excluded. A total of 6 records were included.
We used a standard data extraction method to collect the infor-
mation of each study: author, year of publication, country, sample
size, age interval and gender of the participants, mean follow-up,
retention rate, weight loss, and BMI reduction outcomes reported
on each study. Weight outcomes evaluated were body weight loss
and body mass index reduction after intervention.
To assess the quality of the evidence, we used the Grading
of Recommendations Assessment, Development and Evaluation
(GRADE) system, which defines the quality of the evidence as
high, moderate, low, or very low. The evidence was evaluated
according to the primary outcome (weight loss).
A total of six eligible publications were included, consisting
of six RCTs. Table I summarizes the major characteristics of the
studies included.
One study had an adolescent population with OW/OB without
comorbidities (12), the other five included mixed (13,28-29)
and only female populations (30-31) with OW/OB, and one of
them included OW/OB with diabetes mellitus in both groups
(31). Fiveof the studies reported statistical power and all stud-
ies reported a retention rate higher than 70% at 12 weeks of
Different strategies to weight loss achievement were used:
five of the studies included a weight loss program with hy-
pocaloric diets, physical activity and/or behavioral programs.
Two studies assessed the effect of increasing daily water intake
(12,29), two the effect of replacing caloric beverages with water
following lunch (30-31), and the remaining two studies evaluat-
ed the effect of 500mL of water preload before all 3 daily meals
and before the main meal (13,28).
All studies reported baseline and post-intervention weight,
and four of them also reported BMI reduction (12,13,30,31).
Other measurements were non-uniformly reported: four stud-
ies reported changes in waist circumference, lipid profile and
fasting glucose (13,29-31); two of them reported A1C and in-
sulin resistance indicators (30,31), and two reported body fat
percentage (12,13).
A total of 609 participants were included in this study. Total
size samples ranged from 38 to 303 participants. Gender dis-
tribution was reported in all six studies, and there was a greater
proportion of women (78.1%) than men (21.9%). Age at baseline
ranged from 12 to 75 years. Baseline weight ranged from 83.90
to 93.03 kg, and BMI ranged from 32.0 to 34.2 kg/m2.
[Nutr Hosp 2019;36(6):1424-1429]
Weight loss outcomes in the intervention groups, based on
body weight in kgs, are shown in Table 1. Mean body weight at
baseline and at end of follow-up was 89.33 kg and 84.55 kg,
respectively. After the interventions all the studies showed a
mean weight loss of -4.96 kg, ranging from -0.4 kg to -8.8 kg.
The mean percentage weight loss was 5.15%. The most effec-
tive intervention among the studies was the replacing of caloric
beverages with water, with weight loss ranging between 7.62%
and 9.41% at 24 weeks of follow-up with a significant differ-
ence between groups (31). Interventions involving an increase
in daily water intake were the least effective, with reductions
that ranged from 0.46% to 2.98% at 24 (12) and 52 weeks of
follow-up (29), respectively; differences between groups were
reported only in the 52-week study. Premeal waterload showed
a reduction that ranged from 2.6% to 7.8% at 12 weeks of
follow-up. Both studies found significant differences between
groups (13,28).
The study with the longest follow-up had 52 weeks, and re-
ported a weight loss of 2.98% in the group with higher water
intake (29).
A RCT conducted by Dennis (13) studied the effects of water con-
sumption on body weight. Participants were 55-75-year-old adults
and included predominantly white men. The intervention group (IG)
had a hypocaloric diet plus 500mL of bottled water prior to each of
the three daily meals, and the control group (CG) had a hypocaloric
diet alone. After 12 weeks of follow-up a weight reduction of 7.8%
(p<0.001) was found in the IG, which was approximately 2kg
greater in the water group than in the CG. Weekly water intake
compliance was 90%. There were differences in food and bever-
ages energy density within groups but not between groups at the
end of the study. No differences in mean ad libitum breakfast meal
energy intake at the end of follow-up was found. Most male and
white participants were included in the IG. The Institute for Public
Health and Water Research funded the study.
Parretti et al (28) conducted a RCT to assess the efficacy of
water preloading before meals as a weight loss strategy. All races,
a nonspecific wide age range, and participants with comorbidities
were included. The IG had 500mL of water within 30 min prior
to the main meals each day, without any specific diet, plus a
Table I. Study characteristics and weight loss outcomes
rate (%)
sex (age
range in
2017 (USA) 24 100 38: M/F
(12 to 17)
IG: weight loss diet plus eight cups
per day of water
vs. CG: weight loss diet
IG: -0.4
CG: -0.6 0.90 IG: -0.6
CG: -0.4 0.71
2016 (Iran) 24 80 81: F (18
to 50)
IG: weight loss diet plus post lunch
replacement of DB with water
vs. CG: weight loss diet plus DB
post-lunch daily
IG: -6.4
CG: -5.25 0.006 IG: -2.5
CG: -2.05 0.006
2016 (USA) 52 73 303: M/F
(21 to 65)
IG: weight loss behavioral program
plus 710mL of NSS per day
vs. CG: weight loss behavioral
program plus at least 710mL of
water per day
IG: -8.39
CG: -3.39 < 0.001
2015 (Iran) 24 71 62: F (18
to 50)
IG: weight loss diet plus post lunch
replacement of DB with water vs.
CG: weight loss diet plus DB post-
lunch daily
IG: -8.0
CG: -7.6 0.015 IG: -3.3
CG: -2.9 0.002
12 92.8
84: M/F
IG: no weight loss diet plus
500mL water preload 30 min
before main daily meal
vs. CG: no weight loss diet
IG: -2.4
CG: -1.2 0.028
2010 (USA) 12 85.4 41: M/F
(55 to 75)
IG: weight loss diet plus 500mL
water preload 30 before 3 daily
meals vs. CG: weight loss diet
IG: -0.87
CG: -0.6 < 0.001 IG: -2.6
CG: -1.9
OW: overweight; OB: obese; DM: diabete mellitus; IG: intervention group; CG: control group; DB: diet beverages; CB: caloric beverages; NSS: non-nutritive sweeteners.
1428 G. Bracamontes Castelo et al.
[Nutr Hosp 2019;36(6):1424-1429]
behavioral program. The CG received behavior counseling only.
After 12weeks of follow-up a change of -2.4 ± 3.4 kg was found
in the IG. Twenty-seven percent of the participants lost at least
5% of their body weight; the change in CG was -1.2 ± 2.9 kg; a
difference of -1.3 kg was reported between groups (p=0.028).
The mean difference in weight change between drinking water
three times a day versus no water regimen a day was 3.6 kg (95%
CI -7.0 to 0.2). Private funding was reported.
Madjd et al. (30) conducted a RCT to study the effect of re-
placing diet beverages (DBs) with water during a 24-week weight
loss program with a hypocaloric diet, exercise, and behavioral
support. Participants were 18-50-year-old women without other
comorbidities. Subjects in the IG replaced their usual intake of
DB with 250mL of water after the main meal (lunch), and the CG
was instructed to drink 250mL of DB once a day after lunch, five
times a week, and the resting days only water. In both groups no
water or DBs were allowed during lunch. At the end of follow-up
a weight loss of 8.8 ± 1.9 kg was reported in the IG, and of 7.6
± 2.1 kg in the CG, with a 13.6% greater weight reduction in the
IG (p=0.015) group. A greater improvement in insulin sensitivity
and cardiometabolic risk was found in both groups. The authors
reported no conflicts of interest.
In 2016, Madjd et al. (31) replicated their previous study in
type-2 diabetes female patients. With a larger sample and a re-
tention rate of 80%, they found after 24 weeks of follow-up a
reduction of 7.62% in body weight in the IG, compared to 1.16 kg
in the CG (p=0.006). A greater improvement in fasting plasma
glucose and insulin sensitivity was reported in the IG. There was
a greater reduction in energy intake in the IG compared with the
CG. The authors reported no conflicts of interest.
Peters et al. (29) conducted a RCT to evaluate the effects of
sweetened beverages with non-nutritive sweeteners (NNS) versus
water (WG) in subjects enrolled in a one-year behavioral weight
loss program. The sample consisted on 303 participants aged 21
to 65 years. The NNS group consumed 710mL of NSS per day
and the WG had 710mL of water per day during the 52-week fol-
low-up period. Both the NNS and water treatments were reported
as non-equivalent: the NNS group had greater weight loss, -6.2 ±
7.65 kg (p<0.001) when compared to the WG, with a reduction
of 3.39 ± 6.33 kg. Forty-four percent of the participants in the
NNS group archived a 5% weight reduction, compared to 25.5%
in the WG. This study had the longest follow-up period and the
largest sample. The authors reported private funding for the study.
Wong et al. (12) conducted a RCT in an adolescent population
from 12 to 17 years of age. As an inclusion criterion the participants
had to usually drink ≤ 4 cups of water per day. In addition to a stan-
dardized nutrition and behavioral intervention, the IG was encouraged
to increase water intake to 8 cups per day, referred to as 8×8 (eight
8-oz glasses [1.92 L] of water per day), and the CG received no spe-
cific advice on drinking water but did receive the same nutritional and
behavioral intervention. After 24 weeks of follow-up water intake was
greater in the IG compared with the CG (1.6 cups per day, 95% CI,
-0.2 to -3.0, p=0.03), but the IG did not achieve the 8-cup-per-day
goal. In addition, a significant reduction in BMI z score within groups,
but not between groups, was found. Private funding was declared.
The quality of the evidence was evaluated based on study design,
study quality, consistency, directness, precision, and publication
bias. All the studies reported they had calculated statistical power,
retention rates were high, and no imbalance between intervention
and control groups was found. Four studies reported their ran-
domization procedures (12,28,30,31) and allocation concealment
method (12,28,30,31), and followed an intention-to-treat principle
[12,28,29,31]. While all the interventions tested the effect of water
intake on weight reduction, the strategies used were different: two
tested increase in water intake (12,29), two replacement of caloric
beverages (30,31), and two premeal water load (13,28); and all
the studies but one (28) included a weight loss diet. The length of
the studies ranged from 12 to 52 weeks, and for weight loss lon-
ger-term weight assessments are needed. In five out of six studies
the IG lost more weight than the control group. Four out of six stud-
ies had either industry funding or conflicts of interest with royalties
out of a book promoting water intake. The quality of the evidence
for the primary outcome of body weight loss was low to moderate.
In this systematic review we found that the overall reduction
of the initial weight after a water consumption intervention in
overweight and obese adults and adolescents was 5.15%, which
ranged from 0.46% to 9.41%. However, the quality of the evi-
dence for the effectiveness of water consumption interventions for
weight loss ranged from low to moderate. Intervention strategies
included increased water intake, replacement of caloric beverag-
es, and premeal water load. Caloric beverage replacement was
the most effective approach to weight loss achievement.
These results are consistent with a previous systematic review
published in 2013, which included observational studies, non-ran-
domized trials, and RCTs with short-term follow-up periods. Ourre-
view limited the studies to RCTs with a retention rate higher than
70% and a follow-up of at least 12 weeks. When compared to
other RCTs assessing diet, physical activity, and pharmacological
interventions, water consumption strategies show a quantitavely
similar effect on weight reduction. However, the period of follow-up
prevents long-term (more than a year) predictions regarding weight
loss. Additionally, heterogeneous samples and low to moderate
quality of the evidence are the main limitations of these results.
Public health programs and RCTs focusing on reducing energy
intake from food usually give little value to fluid consumption, but
the findings of this review indicate that the strength of the evi-
dence for the effect of water intake, water replacement, or water
load is low to moderate.
Among the strengths of this study are that all the studies in-
cluded were well designed, randomized, controlled trials, had a
follow-up of at least 12 weeks, and at least a 70% retention rate.
As for weaknesses, the studies included were heterogeneous,
thus a meta-analysis could not be conducted, and the quality of
the evidence for weight loss ranged from low to moderate. Other
[Nutr Hosp 2019;36(6):1424-1429]
adiposity indicators were not uniformly reported, and only one
study with one year of follow-up was conducted.
Water consumption interventions in overweight and obese adults
and adolescents resulted in a reduction of 5.15% of initial body
weight. In this systematic review only six studies were included and
the quality of the evidence for the effectiveness of weight loss ranged
from low to moderate. Further high-quality studies with long-term
follow-up are warranted to assess weight loss during more than one
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... Water intake has been shown to help sustain weight loss and lifestyle changes. 60 While both groups in this study reported increased water intake by the end of this program, this behavior was not sustained at the 3-month post data collection among those with FI. At the same time, opposite changes were seen in the consumption of SSB and juices which increased at the 3-month mark after an initial decrease. ...
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Introduction Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity. Objectives The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach. Methods Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months. Results At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without. We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas. Conclusion Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.
... Adequate daily water intake, based on level of activity and body surface area, is estimated to be between 2.5 and 3.5 L/day for adults (Institute of Medicine, 2005), and has been associated with healthy weight and overall health (Popkin et al., 2010;Vargas-Garcia et al., 2017). In addition to weight loss, increased water consumption is also associated with improvements in insulin sensitivity and fasting plasma glucose (Castelo et al., 2019), indicating the importance of water consumption in cardiometabolic risk reduction, independent of the effects on body weight. Despite the accessibility of water and its importance in weight management, behavioral approaches to increase water consumption have not been well studied among individuals with DD. ...
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Individuals with developmental disabilities (DD) are twice as likely to have obesity than non-disabled individuals. Replacing the consumption of sugar sweetened beverages (SSBs) with water has many health benefits, including weight reduction. In this study, a token reinforcement system was implemented to increase water consumption and decrease the consumption of SSBs with 14 adult participants with DD living in a community-based independent supported living (ISL) center. Token reinforcement reduced the consumption of SSBs, with associated reductions in calorie consumption and body weight. Findings are especially important for treatment settings where resources for individualized meal planning and staffing to support comprehensive behavioral interventions may be limited.
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Background: Water is an essential nutrient for cellular homeostasis and life. Drinking ≥ 6 glasses (1.5 L/day) is the recommendation of daily water intake (RIAD). Aim: To characterize water intake, according to sociodemographic, anthropometric and lifestyles variables, in the Chilean adult population. Material and Methods: Analysis of data from 5,520 participants of the 2016-17 National Health Survey. Compliance with RIAD by population groups according to sociodemographic, anthropometric and lifestyle characteristics was studied through logistic regression analyses. Results: Only 27.8% of the national population met the RIAD. Women, people over than 56 years of age, housewives, retired people, widowers, and non-smokers were less likely to meet the RIAD. The likelihood of not complying with RIAD in these segments of the population ranged from 28% to 62%. Conversely, participants who presented a higher likelihood of meeting RIAD were those who co-habiting, had a medium and higher educational level, followed a diet plan, and those who reported a good health and well-being. The likelihood of meeting with the RIAD for these population groups ranged from 47% to 116%. Conclusions: The likelihood of meeting the RIAD varied according to different sociodemographic, anthropometric, and lifestyle variables. Therefore, public policies for promoting water consumption should be focused on all age groups, but especially in those groups with the highest risk of underconsumption.
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Purpose Drinking (plain) water intake has been associated with weight loss and reducing energy intake in intervention trials. In free-living populations, replacing other beverages with drinking water is associated with reduced obesity risk. However, the association of total water intake and its sources, and body fat distribution remain unevaluated. Thus, the aim of this study was to investigate total water intake and its sources and the association with anthropometric measures. Methods Cross-sectional study of 1500 adults aged 18–90 years (Irish National Adult Nutrition Survey, 2008–2010). Total water intake and its sources were estimated using food records. Associations of total water, drinking water, beverage moisture and food moisture intakes split by tertile, and BMI (kg/m²), waist circumference (cm), and bio-impedance derived body fat (%) were evaluated using covariate-adjusted linear regression analyses including adjustment for energy intake and energy expenditure. Results Higher consumption of total water was associated with lower waist circumference [β-coefficient (95% CI), p trend, tertile 3 versus tertile 1: − 2.19 (− 4.06, − 0.32), 0.036], but not BMI [− 0.44 (− 1.16, 0.28), 0.336] or body fat [− 0.87 (− 1.91, 0.17), 0.146]. Higher consumption of drinking water and food moisture were associated with lower BMI [− 0.65 (− 1.30, − 0.01), 0.027; − 0.64 (− 1.41, − 0.13), 0.014, respectively], body fat [− 1.51 (− 2.43, − 0.59), 0.001; − 1.00 (− 2.12, − 0.12), 0.001], and waist circumference [− 2.83 (− 4.51, − 1.16), < 0.001; − 1.84 (− 3.86, − 0.19), 0.082]. Beverage moisture was not associated with any of the anthropometric measurements. Conclusions Consumption of drinking water and food moisture and not total water or beverage moisture were inversely associated with adiposity, independent of energy intake and expenditure. Advice encouraging drinking water and food moisture intake may be beneficial in addition to energy balance advice, in combating obesity.
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To investigate the effect of acute changes of extracellular osmolality on whole body protein and glucose metabolism, we studied 10 male subjects during three conditions: hyperosmolality was induced by fluid restriction and intravenous infusion of hypertonic NaCl [2-5%; (wt/vol)] during 17 h; hypoosmolality was produced by intravenous administration of desmopressin, liberal water drinking, and infusion of hypotonic saline (0.4%); and the isoosmolality study consisted of ad libitum oral water intake by the subjects. Leucine flux ([1-13C]leucine infusion technique), a parameter of whole body protein breakdown, decreased during the hypoosmolality study ( P < 0.02 vs. isoosmolality). The leucine oxidation rate decreased during the hypoosmolality study ( P < 0.005 vs. isoosmolality). Metabolic clearance rate of glucose during hyperinsulinemic-euglycemic clamping increased less during the hypoosmolality study than during the isoosmolality study ( P < 0.04). Plasma insulin decreased, and plasma nonesterified fatty acids, glycerol, and ketone body concentrations and lipid oxidation increased during the hypoosmolality study. It is concluded that acute alterations of plasma osmolality influence whole body protein, glucose, and lipid metabolism; hypoosmolality results in protein sparing associated with increased lipolysis and lipid oxidation and impaired insulin sensitivity.
Objective To examine the secular trends in the association between obesity and hypertension among American adults between 1999 and 2014. Methods Data from the 1999–2014 National Health and Nutrition Examination Survey (eight survey cycles) were used. Obesity was determined from measured body mass index, with hypertension assessed from measured blood pressure and self-reported medication use. Meta-regression was used to examine the linear, quadratic, and cubic trends of the relationship between the observed odds ratio effect sizes (obesity and hypertension) and the NHANES cycles (year) using a random-effects model. Results Across the years of 1999 to 2014, there was a significant, positive linear trend (p = .006) in the association between overweight/obesity and hypertension. Conclusion Our findings suggest that the association between overweight/obesity and hypertension is becoming stronger over time. Continued surveillance of temporal changes associated with obesity and hypertension is necessary to monitor how such changes may underlie changes in the risk for chronic disease. Significance of the Study This novel study evaluates whether the magnitude of association between obesity and hypertension has changed over the last 15-years.
The prevalence of obesity has increased worldwide in the past ~50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as type 2 diabetes mellitus, fatty liver disease, hypertension, myocardial infarction, stroke, dementia, osteoarthritis, obstructive sleep apnoea and several cancers, thereby contributing to a decline in both quality of life and life expectancy. Obesity is also associated with unemployment, social disadvantages and reduced socio-economic productivity, thus increasingly creating an economic burden. Thus far, obesity prevention and treatment strategies — both at the individual and population level — have not been successful in the long term. Lifestyle and behavioural interventions aimed at reducing calorie intake and increasing energy expenditure have limited effectiveness because complex and persistent hormonal, metabolic and neurochemical adaptations defend against weight loss and promote weight regain. Reducing the obesity burden requires approaches that combine individual interventions with changes in the environment and society. Therefore, a better understanding of the remarkable regional differences in obesity prevalence and trends might help to identify societal causes of obesity and provide guidance on which are the most promising intervention strategies.
Purpose of Review The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk. Recent Findings The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in food intake, such as increased consumption of energy-dense and added sugar, have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited. Summary Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.
It is an obligation for all health care providers to participate in obesity management. This article discusses obesity guidelines from The Obesity Society; the Endocrine Society; and the American Association of Clinical Endocrinologists. It reviews and compares findings and recommendations across these guidelines, identifies areas of controversy and concordance, and suggests how primary care practices may make use of the most appropriate recommendations for their circumstances.
Importance: Health care professionals commonly recommend increased water consumption, typically to 8 cups per day, as part of a weight-reducing diet. However, this recommendation is based on limited evidence and virtually no experimental data from the pediatric population. Objective: To compare 2 standardized weight-loss diets among adolescents with overweight or obesity, either with or without additional advice and behavioral support to increase habitual water intake to 8 cups per day. Design, setting, and participants: A randomized clinical, parallel-group trial was conducted between February 2, 2011, and June 26, 2014, at Boston Children's Hospital, Boston, Massachusetts, among 38 adolescents with overweight or obesity who reported drinking 4 cups or less of water per day. Interventions: All participants in both groups received similar weight-reducing interventions, differentiated by advice about water intake (the water group received advice to increase water intake to 8 cups per day; the control group did not receive such advice) but controlled for other dietary recommendations and treatment intensity. The interventions included dietary counseling, daily text messages, and a cookbook with health guides. To support adherence to 8 cups of water per day, the water group received well-defined messages about water through counseling and daily text messages, a water bottle, and a water pitcher with filters. Main outcomes and measures: The primary outcome was 6-month change in body mass index z score. Data analyses followed the intention-to-treat principle. Results: All 38 participants (27 girls and 11 boys; mean [SD] age, 14.9 [1.7] years) completed the study. Both groups reported drinking approximately 2 cups of water per day at baseline. Self-reported change in water intake at 6 months was greater in the water group (difference from baseline, 2.8 cups per day [95% CI, 1.8 to 3.8]; P < .001) compared with that in the control group (difference from baseline, 1.2 cups per day [95% CI, 0.2 to 2.2]; P = .02) (difference between groups, 1.6 cups per day [95% CI, 0.2 to 3.0 cups per day]; P = .03). The 6-month change in body mass index z score did not differ between the water group (difference from baseline, -0.1 [95% CI, -0.2 to -0.0]; P = .005) and the control group (difference from baseline, -0.1 [95% CI, -0.2 to -0.0]; P = .008) (difference between groups, -0.0 [95% CI, -0.1 to 0.1]; P = .88). Conclusions and relevance: Advice and behavioral supports to consume 8 cups of water per day in the context of a weight-reducing diet did not affect body weight among adolescents with overweight or obesity. Despite intensive behavior supports, few adolescents achieved the target of 8 cups of water per day. Environmental interventions to reduce barriers to water consumption at school may be necessary in future research of the feasibility and effectiveness to achieve the target of an intake of 8 cups of water per day in adolescents. Trial registration: Identifier: NCT01044134.
Aims: To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period. Methods: A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program. Results: Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m(2) ; DBs, -2.06 ± 0.62 kg/m(2) ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period. Conclusion: Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program.
Recently it has been suggested that cell volume alterations may represent a new principle of metabolic control. In vivo studies in humans studying metabolic effects of alterations in extracellular osmolality have not been performed vet. To investigate the effects of acute hyper- and hypoosmolality on whole body protein metabolism leucine kinetics were determined in 10 postabsorptive normal male subjects three times. Hyperosmolality was induced by fluid restriction and additional NaCl 2-5% iv (W/V); hypoosomolality by i.v. administration of a synthetic analog of vasopressin (Minirin) and liberal water drinking and infusion of NaCl (0.4%). Whole body protein kinetics, measured using the 1-13C-leucine infusion technique, demonstrated that leucine flux (a parameter of protein breakdown) decreased under hypoosmolal conditions (p<0.02 vs control). Leucine oxidation - a parameter of irreversible catabolism decreased in the hypoosmolality group (-16%, p<0.005 vs control) and remained unchanged in the hyperosmolality group (+4%) and the control group (+9%). Plasma concentrations of insulin and glucose were lower in the hypoosmolality group (p<0.05 or less vs control). Plasma glycerol and acetoacetic acid levels were higher under hypoosmolal conditions (p<0.05 or less vs control). Indirect calorimetry demonstrated that utilization of fat was increased and that of protein and glucose decreased under hypoosmolal conditions (p<0.05 or less vs control). It is concluded that acute hypoosmolality exerts a protein sparing effect with increased utilization of fat and decreased utilization of glucose, a condition resembling that during prolonged starvation.