Artificial sweeteners linked to long-term weight gain, higher body-mass index and risk of heart disease, but we don't know why

Epicurious.com

Artificial sweeteners are "dodgy" when it comes to weight management, and people who use them regularly have higher risks of developing cardiovascular disease and diabetes, and bigger body-mass indexes, a height-weight ratio that indicates obesity.

So say a group of international researchers who reviewed more than 30 studies about the long-term health effects of sugar substitutes, Cleve R. Wootson Jr. reports for The Washington Post. Their research, published in The Canadian Medical Association Journal, covered more than 406,000 people who said they used artificial sweeteners.

Researcher Meghan Azad of the University of Manitoba said that while the studies show a link between artificial sweeteners and body-mass index, “We need more evidence from better-quality studies to know for sure the cause and effect, but there does seem to be at least a question about the daily consumption of these drinks."

The U.S. market for sodas decreased by 0.6 percent between 2011 and 2016, Wootston notes, but "close to half of adults and a quarter of children consume artificial sweeteners every day, according to the Journal of the Academy of Nutrition and Dietetics."

The American Diabetes Association and the American Heart Association approved the use of artificial sweeteners in 2014, but Wootson says people have become increasingly suspicious of aspartame, sucralose and steviocide, (brand names: Equal, Splenda and Stevia, respectively) because studies have linked them to increased belly fat, and "bogus but widespread rumors that they led to things much worse."

The ADA's chief scientific medical and mission officer, William Cefalu, reviewed the study at the Post's request and also concluded that more studies are needed. "He said artificial sweeteners are still a good tool for diabetics trying to reduce carbohydrates and tightly manage their blood-glucose levels. But he stressed moderation, and agreed that more studies about the long-term effects of artificial sweeteners were needed — particularly on people with diabetes," Wootson writes.

Azad said the study found “nonnutritive sweeteners significantly associated with modest long-term increases” in body weight, BMI and waist circumference, which has been linked to a greater risk of heart disease and diabetes.

But she stressed that they still don't know why these associations exists, and noted that most of the studies focused on people who were working to lose weight or had other medical conditions.

Azad offered several possibilities for the link between artificial sweeteners and increased BMI, ranging from the sweeteners causing changes in gut bacteria to the possibility that people who are gaining weight for other reasons may seek out more artificially sweetened foods.

Meanwhile, she advises "consumers to not automatically assume artificially sweetened foods are the healthier alternative," Wootson writes.

Helping parents understand kids' body mass index can thwart obesity, but Kentucky doesn't require BMI to be reported

By Melissa Patrick
Kentucky Health News

Parents are more likely to change their child's lifestyle when schools provide educational materials along with the results of their child's body mass index screening, according to a recent study. But Kentucky has declined to require student BMIs to be measured, or to engage with parents about what they mean.

BMI, a ratio of height to weight, is used as a screening tool to indicate whether a person is underweight, a healthy weight, overweight or obese. A minor with a BMI of 30 is considered obese.

The study, published in the journal Childhood Obesity, analyzed 1,500 parental surveys from 31 Pennsylvania elementary schools, some who had only received their child's BMI results, while others got the results along with access to an online tool that helps parents evaluate their home environments and practices as they relate to nutrition and physical activity.

The tool appears to help parents better understand their child's BMI number, and how that relates to lifestyle changes that could improve health, like increasing fruits and vegetables, decreasing screen time, increasing activity levels and ensuring adequate sleep, Greg Welk, a professor of kinesiology at Iowa State University and leader of the study, said in an ISU news release.

Welk said BMI numbers are of little use if not shared with parents. The American Academy of Pediatrics and the Institute of Medicine have endorsed BMI screening for use in school assessments, but it is important to follow recommended practices for assessment and notification, he added.

A bill was introduced in the 2010 Kentucky General Assembly to increase physical activity in the lower grades, with the stated goal of reducing obesity and improving the body mass index of Kentucky's children, but it didn't pass. The bill would have required schools to collect and track the aggregate BMI of students in these grades.

Since then, Kentucky has added an optional box for health-care providers to include a child's BMI on the physical-examination reports that are required to enter children in kindergarten and sixth grade. Middle-school and high-school students are required to get a physical exam only if they participate in a sport.

Reporting of BMI varies widely among school districts, so the state has data for only 17.3 percent of its students.

If a BMI is provided, individual schools can enter it in a statewide database, which is reported collectively for use in developing school wellness programs, but the data entry is a suggested practice and is not required, said Jaimie Sparks, coordinated school health director at the Kentucky Department of Education, said in an interview.

"We wanted to collect the data from a public health perspective and let its usefulness be in guiding decisions, say around chronic disease and obesity. We also wanted to be very careful that discussions around the individual student stayed within the medical home," Sparks said, adding that it was also important to avoid any situation where school personnel might be perceived as health experts.

As of 2012, 21 states were required to measure and collect BMI data, though one-third of the schools in these 21 states had policies that did not require parental notification, said the release.

The Iowa State researchers said their study shows there is potential to increase awareness and access to educational tools related to BMI reports, and if this information prompts parents to make changes, it could help reduce obesity rates. They cited research showing that very few parents identify their own children as having weight problems, though more than 17 percent of American youth are obese.

Covington schools show 'Fitness Rocks' by lowering body mass, lifting the bars of nutrition, wellness and academic achievement

Sparks are flying in Covington Independent Schools. The schools' Fitness Rocks program, which combines fitness and wellness activities in an after-school program four or five days a week to create a healthier community for students, is the reported cause of fire.

The district's after-school student activities are based on the SPARK (Sports, Play and Active Recreation for Kids) curriculum for out-of-school-time, and the district reports great success since the program launched three years ago.

Since then, students' body mass has shrunk 4 percent, and there has been a 6 percent increase in the number of students who engage in at least an hour of daily physical activity and the number of students eating fruits two or more times a day, and vegetables three or more times a day, reports Julie Wohlleb of the Kentucky School Boards Association.

Students in Fitness Rocks also saw a greater increase in their math and science MAP (Measure of Academic Progress) scores than students not participating. “It’s been demonstrated how students who are active 60 minutes or more a day have increased academic success,” Haggard told Wohlleb.  

The program is also being used for professional development for physical education teachers, and "The SPARK curriculum has been really helpful in giving our fitness coaches and PE teachers ways to get all kids engaged no matter their skill level,” Haggard told Wohlleb.

The district started Fitness Rocks three years ago at each of its seven schools through a Carol M. White Physical Education grant from the U. S. Department of Education. The program encourages a range of activities to keep students active, from playing flag football to video games, and so far, 55 percent of elementary students and 19 percent of high school students across the district have participated in the program this year.

In addition to after-school activities, Fitness Rocks provides healthy snacks and sponsors family nights at every school that focus on fitness, wellness and nutrition, and program coordinators are witnessing changes in health behaviors across the district. “We’ve been really working hard, especially this year, at finding a sustainability model because it has been so impactful for the community and parents and students alike; they just love it,” Haggard said. (Read more)

To keep kids from getting fat, use smaller plates and portions, limit TV viewing and make sure they get 10 hours of sleep a night

Kentucky ranks high in child obesity. Parents can make sure their children maintain a healthy weight with three simple suggestions highlighted in recent studies: Serve them meals on smaller, child-size plates, pay attention to what they watch on TV, and make sure they get enough sleep.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, and every third child born who was in the U.S. in 2000 will develop Type 2 diabetes if current trends continue, says a recent report from the University of Kentucky's College of Public Health.

The three suggestions are based on three new studies in the April issue of Pediatrics.

One study found first-graders served themselves larger food portions and consumed almost 50 percent of the extra calories they put on their plates when using adult-sized dinner plates instead of child-sized salad plates, reports Michelle Healy of USA Today.
A second study examined the relationship between heavy use of media  and increased body mass index,  a measure based on height and weight that can classify someone as being overweight or obese. It found that TV usage is the most problematic and leads to higher BMI scores, reports Healy. One reason for this may be that TV advertising includes commercials for unhealthy snack foods. Or, perhaps kids are missing out on exercise because they watch so much TV. 

A new sleep study adds to research saying that insufficient sleep may contribute to the rise in adolescent obesity because it changes hormone levels that could lead to overeating and weight gain, reports Healy.

These findings support existing recommendations to help children attain and keep a healthy weight according the UK report. Portion sizes should be a third of adult portions for younger children and two-thirds of adult portions for older children; children's TV screen time should be limited to two hours per day; and children should get 10 hours of sleep each night.

White children exposed to high levels of chemical BPA are five times more likely to be obese, study concludes

White children exposed to high levels of bisphenol A, better known as BPA, are five times more likely to be obese than children with low levels, according to a study published last week in the Journal of the American Medical Association. The study by the New York University School of Medicine is the first to link the chemical to obesity in children, which is especially prevalent in Kentucky.

Environment Health News reporter Brien Bienkowski reports that scientists found traces of BPA, which are used in some canned food and beverages, paper receipts and dental sealants, "are found in virtually every U.S. adult and child. In the study of body mass and BPA data from 2,838 youths aged 6 to 19, only white children were found to have significant increases in obesity prevalence as their BPA levels increased. Those with the highest concentrations in their urine were five times more likely to be obese than children with the lowest levels. Black children with higher BPA levels were 1.25 times more likely to be obese than those with lower levels, which the scientists said is not statistically significant. Hispanic children had the same rates of obesity at the highest and lowest levels."

Bienkowski reports that "representatives from the chemical industry said the study had too many weaknesses to prove any connection. Steven Hentges, from the American Chemistry Council's Polycarbonate/BPA Global Group, said that attempts 'to link our national obesity problem to minute exposures to chemicals found in common, everyday products are a distraction from the real efforts underway to address this important national health issue.' "

One study of preschoolers in North Carolina and Ohio found that 99 percent of BPA exposure was through food. But since the chemical is in many plastics and other products, this is difficult for scientists to pin down. “People are always told if you just stop eating or exercise more, you will lose weight. But there may be more to it … and I think there is,” said Retha Newbold, a visiting scientist at the National Institute of Environmental Health Sciences, who specializes in BPA and other endocrine-disrupting chemicals.  (Read more)

James Bruggers, environmental writer for The Courier-Journal, noted the report here.