Each month, The Clinical Advisor makes one new clinical feature available ahead of print. Don’t forget to take the poll. The results will be published in the next month’s issue.
Obesity is defined as a weight higher than normal for a given height.1 In the United States, healthcare providers are faced with a national obesity epidemic, as obesity rates have risen at an alarming pace since the middle of the 1970s.1 During this time period, obesity rates more than tripled for some pediatric age groups. According to the Centers for Disease Control and Prevention, an estimated 1 out of every 3 children aged 2 to 19 years is overweight or obese in the United States.2 Rates differ for various groups from state to state but remain high across the board nationally. Certain ethnic groups and low-income families have higher rates of obesity.2 Obesity is the most common nutrition disorder seen by healthcare providers among children and adolescents.3 If obesity rates continue to rise, today’s youth could possibly have shorter life spans than their parents due to poor health.
Overweight and obese children have a greater risk for cardiovascular disease, hypertension, and type 2 diabetes, and are more likely to remain overweight or obese into adulthood.4 As children become adults, these obese individuals are at greater risk for the same conditions in addition to some forms of cancer, dementia, and other health concerns.4 In addition, childhood obesity has the potential to cause emotional and psychological issues such as behavior problems, depression, eating disorders, learning difficulties, low self-concept, and negative body image.5 Overall, obesity is not a single condition but a complex disorder that affects the body in a multitude of ways.
The development of obesity involves several elements such as dietary habits, environment, genetics, lifestyle, and metabolism.3 Although most overweight children have at least 1 obese parent, genetics and hormonal issues only account <10% of all obesity cases.3 Weight gain occurs when caloric intake is greater than output; ie, eating too much without enough exercise. Obese children learn unhealthy familial patterns of food intake, exercise, and selection of leisure activities that encourage increased intake with decreased output from their parents and other family members.3
A common approach to children and families with obesity issues is to provide education on healthy diets, making better food choices, and decreasing sugar intake from items such as carbonated beverages. A popular substitution for sugary drinks has been artificially sweetened, zero-calorie beverages. However, new research indicates that artificial sweeteners may not be a healthy substitute, and studies have suggested a positive correlation between artificially sweetened beverages (ASBs) and weight gain in children.6 Laverty and colleagues suggest artificial sweeteners may be stimulating children’s appetites and leading to overconsumption of food.7 According to the Harvard School of Public Health, a study examining the relationship between ASBs and weight in 3682 participants over a 7- to 8-year period found an approximately 45% increase in body mass index (BMI) in participants consuming ASBs compared with those who did not consume ASBs.8 These data prompt the question: In the pediatric population, does drinking ASBs increase the risk of obesity compared with drinking other zero-calorie beverages?
Although current literature provides numerous potential causes behind obesity, effective solutions are limited. This literature review will examine the effects of zero-calorie beverages on weight in the pediatric population. In addition, it will support the need for further research on the relationship between artificial sweeteners and weight.
The literature review process began with developing inclusion criteria. Literature concentrating on the effects of sugar-free sweetened products on body weight in the pediatric population published between 2012 and 2017 was considered for inclusion. The next step in the process was the development of initial keywords and phrases. An array of keywords and phrases were used individually and in a variety of combinations to locate information relevant to the subject matter within selected databases and search engines. Initial keywords and phrases included weight loss, artificial sweetener, children, obesity, sugar-free, sugar-free beverages, non-nutritive sweeteners, water, weight gain, and pediatric. Appropriate databases and search engines were then selected. The initial search was initiated within the Cochrane Library with additional database searches of CINAHL, MEDLINE, SportDiscus, and PsycInfo completed with EBSCOhost. The Google Scholar search engine was used to find supplemental scholarly articles related to the topic. By using keywords and phrases with the inclusion criteria, a list of applicable nonduplicated literature was created for the review.
Initially, the process began with a search for “artificial sweetener” in the Cochrane database that produced 60 study results. By adding “children” to the search criteria, the results were refined to 4 trials, of which only 3 studied artificial sweeteners in pediatric populations, with 2 addressing behavior issues and the third examining dental caries. After performing searches using keyword and phrase combinations, the Cochrane Library yielded 102 trial results and 0 Cochrane reviews. Only 1 trial could be applied to the topic literature review after applying inclusion criteria and removing duplicate findings. Searches of the remaining databases were performed using EBSCOhost with the same keywords and phrases to locate literature published in the past 5 years, yielding 407 results. Using the same criteria and time frame, Google Scholar provided the most results on the initial search, with 16,700 results. To refine the searches in both EBSCOhost and Google Scholar, more specific keywords and phrases were used to eliminate unrelated material for a total of 8 additional meta-analyses and trials for use in the literature review. In general, the databases provided a limited number of results, and Google Scholar delivered the most results pertaining to the effects of artificial sweeteners on weight loss in the pediatric population. The final review of literature consisted of 9 studies.