The World Health Organization (WHO) has revealed new guidelines, stating that non-sugar sweeteners (NSS) should no longer be viewed to support weight control, or reduce the risk of noncommunicable diseases (NCDs). Examples of NSS include, but are not limited to, acesulfame K, aspartame, saccharin, sucralose, and stevia-derived sweeteners. These Non-nutritive Sugar Sweetener may be either synthetic or natural low-initiating or no-calorie sweeteners that are widely used as table sugar substitutes in foods and beverages.
WHO Guidance on Non-Sugar Sweeteners (NSS) for Weight Loss: Overview and New Recommendations
The World Health Organization (WHO) has revealed new guidelines, stating that non-sugar sweeteners (NSS) should no longer be viewed to support weight control, or reduce the risk of noncommunicable diseases (NCDs). Examples of NSS include, but are not limited to, acesulfame K, aspartame, saccharin, sucralose, and stevia-derived sweeteners. These Non-nutritive Sugar Sweetener may be either synthetic or natural low-initiating or no-calorie sweeteners that are widely used as table sugar substitutes in foods and beverages.
As with other WHO guidelines, this new recommendation is based on a systematic review of the evidence, with over 280 studies reviewed, including randomized controlled trials (RCTs), cohort, and observational studies with adults, children, and pregnant women without pre-existing diabetes. Although some of the trials found short-term reduction in weight following use of NSS, the current systematic review of the evidence does not support a sustained or meaningful long-term reduction in body fat or reduction in cardiometabolic outcomes with the use of NSS. The WHO instead recommends reducing overall sweetness of consumption in the diet, beginning early in life, with dietary approaches that include naturally occurring sugars, and unsweetened foods. [1]
Health Risks and Concerns Linked to NSS Consumption
The long-term observation of NSS usage has produced multiple concerns about its safety. The WHO review established that adults who consume NSS face elevated risks of type 2 diabetes and cardiovascular diseases and death from any cause. The research shows that NSS consumption leads to no nutritional value while potentially causing dangerous health problems.
- The research shows that drinking NSS beverages leads to type 2 diabetes development at rates ranging from 23% to 34% regardless of the beverage format.
- The research shows that people who consume NSS beverages daily face a 12% higher chance of death from any cause.
- The research shows that cardiovascular disease risks rose by 19% while stroke and coronary heart events and hypertension developed at higher rates.
The BMI adjustment process weakens these associations but does not remove the existing health risks which indicate weight-independent adverse effects. [2]
Scope of the WHO Recommendation
The guideline targets all non-sugar sweeteners used in food and beverage manufacturing for public consumption except for low-calorie sugars and sugar alcohols. The definition of NSS includes all synthetic and naturally occurring or modified non-nutritive sweeteners which exclude low-calorie sugars and sugar alcohols because they contain calories and have different nutritional profiles.
The guideline includes both commercial food products and consumer-grade sweetener products that people use to sweeten their food and beverages. The guidance applies to five common NSS ingredients which include aspartame and sucralose and saccharin and acesulfame K and stevia. These findings have implications for food product formulation and innovation, urging careful consideration in the design of health-conscious product development, particularly related to sweetness levels. [1]
Review Details and Study Design
The WHO-commissioned review analyzed a broad range of evidence which included:
- The research included 50 randomized controlled trials that studied body weight changes and metabolic effects directly.
- The research included 97 cohort studies which monitored diabetes and cardiovascular events and mortality rates and cancer incidence and dental caries and neurological effects in patients over extended periods.
- The research included observational and case-control studies which examined different population groups including children and pregnant women.
The research spanned from short-term RCTs that lasted between days to months to long-term observational cohorts which studied effects over multiple years. [3]
Key Findings Summarized
Impact on Adiposity and Weight Control
- The analysis of 32 randomized trials showed NSS use led to a 0.71 kg weight decrease but this difference was not statistically significant.
- The evidence from longer-duration studies showed slightly better weight loss results but the overall findings remained unclear.
- Most studies showed NSS had no significant impact on hunger or appetite but the evidence about eating behavior changes was inconsistent.
Associations with Type 2 Diabetes
- Multiple prospective cohort studies demonstrated that people who consumed more NSS had a 23-34% higher chance of developing type 2 diabetes.
- The consumption of NSS linked to elevated fasting glucose levels which serve as an early indicator of glucose metabolism problems.
Mortality and Cardiovascular Disease Risks
- People who drank NSS regularly faced a 12% higher chance of dying from any cause.
- NSS consumption led to a 19% increase in cardiovascular deaths while also raising the risk of stroke and coronary events and hypertension.
- The associations between NSS consumption and increased mortality risk remained significant after researchers controlled for obesity and other influencing factors which suggested direct health effects.
Effects in Children and Pregnant Women
- The available research about NSS effects on children’s weight and metabolic health remains insufficient to draw definitive conclusions.
- Research indicates that pregnant women who consume higher amounts of NSS may face elevated risks of premature birth, and their babies might develop excess body fat although the research evidence remains weak. [4] [5]
Summary Table: Health Risks and Effects of Non-Sugar Sweeteners
Health Outcome | Evidence Source | Effect Size / Risk | Notes |
Weight loss/adiposity | RCTs | ~0.7 kg reduction (ns) | Small, inconclusive effect |
Type 2 diabetes risk | Prospective cohort studies | 23-34% increased risk | Consistent across NSS forms |
All-cause mortality | Cohort studies | 12% increased risk | Adjusted but persistent association |
Cardiovascular disease | Cohort studies | 19% increased risk | Includes stroke, coronary events, hypertension |
Preterm birth (pregnant) | Observational studies | ~25% increased risk | Evidence certainty low |
Effects in children | Limited data | Inconclusive | More research needed |
Product Example
Product Name: EverSweet® Stevia Sweetener
Brand Name: Cargill (Avansya joint venture with dsm-firmenich)
Product Category: Zero-Calorie, Next-Generation Non-Nutritive Sugar Sweetener (Stevia-Derived)
Regulatory Update: Approved for use in the US, Canada, Mexico, UK, and EU with positive safety evaluations.
Used For: Widely used in beverages, dairy, confectionery, bakery, and nutritional products for food product formulation and innovation. It enables up to 100% sugar reduction with a clean, sugar-like taste, supporting health-conscious product development and improved flavor product development.
Conclusions and Cautions
The World Health Organization has reported that although RCTs demonstrate short-term benefits to weight loss, these do not lead to better long-term management of body weight or cardiometabolic health. Long-term NSS use is correlated with a greater risk of diabetes, cardiovascular disease, and all-cause mortality. It is possible some of these associations may represent reverse causation, as obesity and metabolic conditions may drive NSS use among others.
WHO supports strategies to reduce total dietary sweetness through food product development focusing on natural low-sugar ingredients and unsweetened options instead of relying on non-nutritive sugar sweeteners as sugar substitutes.
Industry Response
The Calorie Control Council which represents artificial sweetener manufacturers disagrees with the WHO’s final assessment. The industry maintains that artificial sweeteners provide safe and effective solutions for weight management and disease prevention while specifically helping diabetic and pre-diabetic patients who were omitted from the WHO review. The industry values NSS as a tool in flavor product development and public health initiatives combating obesity and diabetes. [6]
Key Takeaway
The World Health Organization recommends people should avoid using non-sugar sweeteners for weight management and disease prevention. The World Health Organization advises people to reduce their overall food sweetness intake for better long-term wellness outcomes.
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