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



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.

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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.

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Correspondence to A Madjd or H R Farshchi.

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Madjd, A., Taylor, M., Delavari, A. et al. Effects of replacing diet beverages with water on weight loss and weight maintenance: 18-month follow-up, randomized clinical trial. Int J Obes 42, 835–840 (2018). https://doi.org/10.1038/ijo.2017.306

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