UK Dietitians’ and Nutritionists’ Perceptions of Low-Calorie Sweeteners in Obesity and Type 2 Diabetes Management: A Cross-Sectional Survey

Low-calorie sweeteners (LCS), also known as non-nutritive sweeteners, are suggested to reduce sugar and calorie intake, potentially serving as a useful strategy for weight loss and management of type 2 diabetes (T2D) (1) . However, inconsistencies in scientific research and conflicting guidelines regarding the benefits and risks of LCS rendered professionals uncertain about their safety and effectiveness in the management of obesity and T2D (2) . Dietitians and nutritionists play a crucial role in preventing and managing obesity and T2D. Understanding their perceptions and knowledge of LCS is essential for developing strategies to keep them updated with the latest evidence. This survey aimed to assess the perceptions and knowledge of LCS among HCPC registered dietitians and nutritionists living and working in the UK. An online cross-sectional survey was distributed to nutritionists and HCPC registered dietitians in the UK through social media and workplaces such as gyms, hospitals, and universities. Participants rated statements on their perceptions and knowledge of LCS use in obesity and T2D management, their risks, benefits, and government regulations. Ordinal logistic regression was used to investigate the impact of educational level and occupation (dietitians versus nutritionists) on the outcomes. A total of 200 participants (136 dietitians and 54 nutritionists) responded to the survey. While 99% of respondents were familiar with LCS, only 62.5% were confident about advising clients/patients on their appropriate use. Additionally, 69.9% believed that LCS are helpful for weight loss and 67.8% stated that they can help manage T2D. Some respondents viewed LCS negatively: 15.5% considered it harmful, 39% deemed it unsafe, while 42.5% saw its benefits outweighing risks. Interestingly, 41.5% of respondents were not aware of the regulations surrounding the use of LCS. Open-ended questions revealed that some participants expressed concerns about the negative health effects of aspartame, with many considering stevia to be a healthier alternative due to its natural origin. Further analysis revealed that professionals with a doctorate degree in Nutrition/Dietetics were less likely to believe that LCS are bad for health when compared to those with an undergraduate degree (Wald χ2(1) =4.209, p=0.04). Compared to nutritionists, dietitians were more likely to express concerns regarding the impact of LCS on weight gain (p=0.029), yet the latter outcome is limited by the unequal sample size between the 2 groups. While the majority of respondents recognize LCS as a valuable tool in managing obesity and T2D, a research and educational knowledge gap remains. Perceptions and knowledge of LCS could be further explored in a larger survey. It is crucial for professional and regulatory bodies to disseminate accessible information, ensuring that healthcare professionals provide the public with evidencebased guidance on the use of LCS in addressing obesity and T2D.