Original Article | Published:

Effects of replacing diet beverages with water on weight loss and weight maintenance: 18-month follow-up, randomized clinical trial

International Journal of Obesity volume 42, pages 835840 (2018) | Download Citation



Beneficial effects of replacing diet beverages (DBs) with water on weight loss, during a 24-week hypoenergetic diet were previously observed. However, it is not known whether this difference is sustained during a subsequent 12-month weight maintenance period.


To evaluate effects of replacing DBs with water on body weight maintenance over a 12-month period in participants who undertook a 6-month weight loss plan.


Seventy-one obese and overweight adult women (body mass index (BMI): 27–40 kg m–2; age: 18–50 years) who usually consumed DBs in their diet were randomly assigned to either substitute water for DBs (water group: 35) or continue drinking DBs five times per week (DBs group: 36) after their lunch for the 6-month weight loss intervention and subsequent 12-month weight maintenance program.


A total of 71 participants who were randomly assigned were included in the study by using an intention-to-treat analysis. Greater additional weight loss (mean±s.d.) in the water group was observed compared with the DBs group after the 12-month follow-up period (−1.7±2.8 vs −0.1±2.7 kg, P=0.001). BMI decreased more in the water group than in the DBs group (−0.7±1 vs −0.05±1.1 kg m2, P=0.003). There was also a greater reduction in fasting insulin levels (−0.5±1.4 vs −0.02±1.5 mmol l–1, P=0.023), better improvement in homeostasis model assessment of insulin resistance (−0.2±0.4 vs −0.1±0.3, P=0.013) and a greater decrease in 2-h postprandial plasma glucose (−0.2±0.3 vs −0.1±0.3 mmol l–1, P<0.001) in the water group compared with the DBs over the 12-month weight maintenance period.


Replacement of DBs with water after the main meal in women who were regular users of DBs may cause further weight reduction during a 12-month weight maintenance program. It may also offer benefits in carbohydrate metabolism including improvement of insulin resistance over the long-term weight maintenance period.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , . Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 2007; 97: 667–675.

  2. 2.

    , . Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84: 274–288.

  3. 3.

    , , , , . Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010; 33: 2477–2483.

  4. 4.

    , , , , , , , . Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007; 116: 480–488.

  5. 5.

    , , , , , et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes 2016; 40p 381–394.

  6. 6.

    , . Intense sweeteners, energy intake and the control of body weight. Eur J Clin Nutr 2007; 61: 691–700.

  7. 7.

    , . Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2009; 89: 1–14.

  8. 8.

    , . Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr 2014; 100: 765–777.

  9. 9.

    . Intense sweeteners and the control of appetite. Nutr Rev 1995; 53: 1–7.

  10. 10.

    , , , . Drinking water is associated with weight loss in overweight dieting women independent of diet and activity. Obesity 2008; 16: 2481–2488.

  11. 11.

    , , , , , et al. Water consumption increases weight loss during a hypocaloric diet intervention in middle‐aged and older adults. Obesity 2010; 18: 300–307.

  12. 12.

    , , , , , et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am J Clin Nutr 2012; 95: 555–563.

  13. 13.

    , , , , , et al. The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program. Obesity 2014; 22: 1415–1421.

  14. 14.

    , , , , , et al. The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: a randomized clinical trial. Obesity (Silver Spring) 2016; 24: 297–304.

  15. 15.

    , , , , , . Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial. Am J Clin Nutr 2015; 102: 1305–1312.

  16. 16.

    , . Screening depressive patients in family practice. Postgrad Med 1972; 11: 561–579.

  17. 17.

    , , . American College of Sport Medicine ACSM’s Guidelines for Exercise Testing and Prescription 8 Painos. Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2009.

  18. 18.

    NHLBI Obesity Education Initiative Expert (NOEIE) panel on theidentification, evaluation, and treatment of obesity in adults. NIH: Bethesda, MD, USA, 1998.

  19. 19.

    National Institutes of Health, Lung, and Blood InstituteNHLBI Obesity Education Initiative the Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Heart, Lung, and Blood Institute: Bethesda, MD, USA, 2000.

  20. 20.

    , , , , . A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr 1997; 66: 239–246.

  21. 21.

    , , , , . Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring) 2008; 16: 1894–1900.

  22. 22.

    , . Artificial sweetener use and one-year weight change among women. Prev Med 1986; 15: 195–202.

  23. 23.

    , , , , , (eds) Diet soft drink consumption is associated with increased incidence of overweight and obesity in the San Antonio Heart Study. Diabetes; 2005: AMER DIABETES ASSOC 1701N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717, USA.

  24. 24.

    , , , . Healthy strategies for successful weight loss and weight maintenance: a systematic review. Appl Physiol Nutr Metab 2013; 39: 1–20.

  25. 25.

    . Atkins’ NEW Diet Revolution. Avon Books: New York, NY, USA, 1992.

  26. 26.

    , . The Zone. Harper Collins: New York, NY, USA, 1995.

  27. 27.

    , , , , , et al. Long-term weight loss maintenance in the United States. Int J Obes (2005) 2010; 34: 1644–1654.

Download references


We thank the staff of NovinDiet Clinic, Mansoureh Pahlevani, Zeynab Zolfaghari, Rahil Ahmadi and Ziba Hooshmand, for their assistance in data collection and Dr Masoud Solaymani and Dr Leila Janani, for their statistical consultation. Thanks also go to Dr Asadi at Jaam e Jam Laboratory for the analysis of blood samples. We also thank Abigail Barrett for her hypothesis that if people are in a protocol doing one healthy thing, it could motivate to do more healthy options, which we have used in the discussion. This study was supported by the School of Life Sciences, the University of Nottingham, UK and the Digestive Disease Research Institute (DDRI), affiliated to Tehran University of Medical Sciences (TUMS).

Author contributions

Experiments in this study were conducted in NovinDiet Clinic, Tehran. AM: contributed to the initial study design, study protocol setup, data collection, data analysis, and writing of the first draft of the manuscript. HRF: designed the research, conducted the research, contribution to data interpretation, revision of the manuscript and provided medical supervision. MAT, IAM: refined the study design and contributed to data interpretation and redrafting of the manuscript. RM and AD: provided advice and consultation for the study design, conducted the research. All authors read and approved the final manuscript.

Author information


  1. School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK

    • A Madjd
    • , M A Taylor
    • , I A Macdonald
    •  & H R Farshchi
  2. NovinDiet Clinic, Tehran, Iran

    • A Madjd
    •  & H R Farshchi
  3. Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    • A Delavari
    •  & R Malekzadeh


  1. Search for A Madjd in:

  2. Search for M A Taylor in:

  3. Search for A Delavari in:

  4. Search for R Malekzadeh in:

  5. Search for I A Macdonald in:

  6. Search for H R Farshchi in:

Competing interests

The authors declare no conflict of interest.

Corresponding authors

Correspondence to A Madjd or H R Farshchi.

About this article

Publication history







Further reading