Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 22301929 · doi:10.3945/ajcn.111.026278
What was done
A 6-month randomized clinical trial (CHOICE trial) evaluated the effect of substituting caloric beverages (≥200 kcal/day) with noncaloric options in 318 overweight and obese adults (mean BMI 36.3 ± 5.9 kg/m²; 84% female; 54% Black; mean age 42 ± 10.7 years). Participants were randomized to replace caloric beverages with water, replace them with diet beverages (DBs), or receive an attention control (AC) intervention where they made self-selected dietary changes. Outcomes included changes in body weight, waist circumference, blood pressure, fasting glucose, and hydration.
What was found
Across all groups from baseline to 6 months, significant reductions were observed in weight, waist circumference, and systolic blood pressure. Mean (± SEM) weight reductions were -2.5 ± 0.45% in the DB group, -2.03 ± 0.40% in the water group, and -1.76 ± 0.35% in the AC group, with no statistically significant differences in mean weight loss between groups. However, the odds of achieving a clinically relevant ≥5% weight loss were significantly higher in the DB group compared to the AC group (OR: 2.29; 95% CI: 1.05, 5.01; P = 0.04) and in the combined beverage replacement groups versus AC (OR: 2.07; 95% CI: 1.02, 4.22; P = 0.04). Relative to AC, the water group showed a significant reduction in fasting glucose at 6 months (P = 0.019) and improved hydration at 3 months (P = 0.0017) and 6 months (P = 0.049).
Why it matters
Replacing sugary or caloric beverages with either water or diet drinks provides a simple, actionable behavioral target that doubles the likelihood of achieving a clinically meaningful 5% weight reduction over 6 months compared to general dietary advice.
Limits
The difference in mean percentage weight loss among the three groups did not reach statistical significance. The study duration was limited to 6 months, leaving long-term weight maintenance unknown. The sample was predominantly female (84%), which may limit generalizability to men. Energy intake compensation and dietary adherence mechanisms were not detailed in the abstract.
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