A recent study published in the European Journal of Public Health has identified uncertainty surrounding sweeteners among dietitians, which is reflected by the diversity of positions taken by the media, public health information and non-governmental organisations.
Researchers from the University of Bath and Plymouth University, based in the UK, and the European Food Information Council, in Belgium, examined dietitians' perceptions of sweeteners and the practical advice they provide about them.For some people, lowering the energy or calories consumed from food and drink, when combined with physical activity, is essential to achieve and maintain a healthy weight. One way of lowering calories is the substitution of sugar with low or zero calorie sweeteners. Although official statements such as the most recent one from the European Food Safety Authority (EFSA) confirm that sweeteners are safe, there is contention around their safety and potential side effects.
Supporters of sweeteners argue that the media tends to report negatively on issues related to sweeteners and several studies support this position, according to the researchers. The fact that there is little research on the perceptions of dietitians and other health professionals responsible for providing weight management advice prompted this qualitative study.
The study was organised in two phases. It included 75 registered dietitians from five European countries (France, Germany, Hungary, Portugal and United Kingdom) in phase one, then 76 dietitians in phase two. In phase one, face-to-face interviews were conducted to understand dietitians' positions on the role of low-calorie sweeteners in weight loss. The researchers sought dietitians' views around swapping sweeteners as an alternative to sugar, including views on using diet soft drinks to help lower calorie intake.
Phase two aimed to supplement statements of the face-to-face interviews in phase one by enabling views to be provided anonymously using an online tool. The tool enabled the researchers to present an information snapshot through vignettes to dietitians, eliciting participants' questions and comments. For example, one of the vignettes presented a summary of consumer views on sweeteners: positive, negative and uncertain.
Dietitians' perceptions turned out to be uncertain, ambivalent and divergent, which resulted in general suspicion, fear and even refusal in some cases to recommend sweeteners to their patients.
When dietitians are called upon to confidently disseminate trustworthy information, both to the public and their clients, this ideally means taking a clear position about the subject; in reality this can also mean communicating about 'uncertainty'. In this case, a clear, unambiguous approach to the issue can emerge as either a rejection, acceptance of sweeteners or the limited use of them.
One of the reasons why some dietitians would not advocate sweeteners is because they feel it is important for consumers to reduce their attachment to 'sweet tastes'. The combination of perceived 'unnaturalness', historically conflicting scientific findings and contradictory public communication has a strong influence on dietitians' perceptions of sweeteners. As a result, the researchers found there is an uncertainty and disagreement amongst some dietitians to recommend sweeteners within weight management programmes.
In addition, the lack of clear official statements or guidance on sweeteners in Europe is one of the possible reasons dietitians continue to be uncertain and dubious, when it comes to advising sugar substitutes to their clients. While in the United States, the dietitians' professional body, the Academy of Nutrition and Dietetics, has issued an official position on sweeteners and guidelines for addressing the issue in consultations, there seems to be no equivalent guidance for dealing with the issue in professional dietetic contexts within Europe. The researchers argue that communicating a clear position with respect to recent scientific evidence provided by an official authority (EFSA) would significantly alleviate dietitians' uncertainty and increase public confidence and trust toward sweeteners.