WHO sweeteners guidelines a ‘disservice to public health’

The International Sweeteners Association (ISA) has called the publication of the World Health Organization’s (WHO) guideline on the use of non-sugar sweeteners a “disservice to public health”.

The WHO guideline, which the body itself admits is a conditional recommendation based on evidence of low-certainty, was published on 15 May 2023. It suggests that non-sugar sweeteners shouldn’t be used as a means of achieving weight control or reducing the risk of non-communicable diseases.

An ISA spokesperson said: “In light of the global effort to address the burden of non-communicable diseases (NCDs), including dental diseases which are the most prevalent NCD globally, and other societal challenges such as the global obesity crisis, the ISA believes it is a disservice to public health to not recognise low/no calorie sweeteners’ role in reducing sugar and calorie intake and aiding in weight control.

“The ISA believes this guideline should have been based on the comprehensive set of available evidence and interpreted considering the hierarchy and weight of scientific evidence. The WHO could only conclude a conditional recommendation, which is not scientifically rigorous, nor based on a robust evidence base or supported by the evidence presented in the WHO-commissioned systematic review itself.

“The ISA joins others, including relevant government agencies around the globe, who have responded to the public consultation on the draft guideline expressing their concerns about the conclusions and rationale used by WHO. The ISA agrees with the UK’s Office for Health Improvement and Disparities that commented ‘the guideline may go too far’ and with the Australian government’s Department of Health and Aged Care who wrote that ‘the recommendation may result in undesirable health outcomes for some individuals.'”

ISA Chairman Bob Peterson added: “Food and beverage companies have reformulated products as part of a comprehensive, global effort to meet public health recommendations (including from the WHO) for sugar reduction. Low/no calorie sweeteners have enabled this innovation and ultimately contribute to the creation of healthier food environments by allowing people to enjoy food and drinks with less sugar and fewer calories, while still meeting their taste preferences.”

Prof Nita Forouhi, MRC Epidemiology Unit, University of Cambridge, said: “The findings of the WHO report are justifiable for general populations of people without diabetes, based on the inclusion of all eligible evidence from multiple research study designs, but are limited by several factors, many of which the report acknowledged. Notably, the WHO recommendation on avoiding the use of non-sugar sweeteners for longer term weight management or chronic disease prevention is conditional, therefore context and country specific policy decisions may be needed rather than necessarily being universally implemented as they stand. The role of non-sugar sweeteners as a way to reduce calories in the short-term is, however, supported by evidence – so using sweeteners can be part of interventions to manage weight in the short term.”