The paradox of artificial sweeteners in managing obesity.

The role of artificial sweeteners in the management of obesity is controversial. Observational data have suggested that nonnutritive sweeteners (NNSs) may promote weight gain through poorly understood mechanisms of cravings, reward phenomenon, and addictive behavior via opioid receptors. Interventional studies suggest the opposite that substitution of NNS for sugar-sweetened beverages (SSBs) results in reduced caloric intake and modest degrees of weight loss. Whether the use of NNS provides benefit toward weight reduction in the individual patient may depend on the characteristics of their baseline diet, associated changes, or dietary compensation involved with ingestion of NNS, and the degree of compliance with a more complete weight loss program.