Obesity and its associated metabolic conditions, like diabetes and cardiovascular disease, are now among the leading causes of preventable death in the U.S. The obesity epidemic has been linked in part to an increase in added sugar consumption over the past century.

In order to help address it, in 2015 the WHO issued specific recommendations to reduce sugar intake and adopt healthier diets.

But humans are hard-wired to find the sweet taste of sugars pleasurable, and the tastiness of real sugar makes it difficult for most of us to remove it from our diets.

Sugar substitutes were designed to help. The math seems straightforward: Replacing your favorite 12-ounce sugar-sweetened beverage that contains 150 calories with an artificially sweetened beverage of the same volume that contains zero calories should allow you to reduce the number of calories you take in each day and reduce your body weight over time.

But the science is not so straightforward. Research from both animal models and humans indicates that habitual nonsugar sweetener consumption can lead to long-term negative metabolic outcomes and body weight gain.

However, there are conflicting studies from animal models and humans that have not found significant body weight gain associated with nonsugar sweeteners consumption.

Regardless of any potential benefits nonsugar sweeteners may have for weight control, their use must also be considered in the context of overall health.

Agencies like the WHO and the U.S. Food and Drug Administration periodically review available evidence and assess the safety of various food additives, including nonsugar sweeteners, for use in foods and beverages within what is called an acceptable daily intake limit. In this context, the acceptable daily intake is based on the estimated amount of a specific nonsugar sweetener that can be safely consumed daily over one’s entire life without adverse effects on health.

Each agency sets its own daily allowance based on the best available data. But because these experiments cannot account for all possible conditions in which these substances are used in real life, it is critical that scientists continue to investigate the health effects of food additives.

The authors of the WHO report relied on three main types of published research studies to determine whether nonsugar sweetener consumption was linked to adverse health effects. The gold standard for assessing causation is what are called randomized controlled trials.

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