Body Weight Management Research Articles

On the estimation and control of human body composition

Obesity is a chronic disease that can lead to an increased risk of other serious chronic diseases and even death. We present switching and time-delayed feedback-based model-free control methods for the dynamic management of body mass and its major components. The estimation of body composition based on human body weight dynamics is proposed using a soft switching-based observer. Additionally, this paper addresses the control allocation problem for optimal body weight management using linear algebraic equivalence of the nonlinear controllers based on dynamic behaviour of body composition described in literature. A control allocator system computes the required energy intake and energy expenditure from a controlling range of inputs to track the desired trajectory of body mass by optimizing a weighted quadratic function. Simulation results validate the performance of the proposed controllers and the observer under disturbances in energy intake and energy expenditure.

How to improve food choices through vending machines: The importance of healthy food availability and consumers’ awareness

Vending machines (VMs) have been pointed out as an obesogenic factor contributing to increase the availability of unhealthy foods throughout the day. They usually offer nutrient-poor and energy-dense products, while healthy options are scarce or even absent. This study was carried out between April 2014 and December 2015 at the University of Parma (North Italy) to increase purchases of healthy foods in VMs through the enhancement of healthy product availability and the promotion of healthier food options through nutrition communication. Choices were retrospectively measured by comparing the amount of sales for 24weeks at baseline and after improving the nutritional quality of products, with or without additional nutrition communication. Purchase of healthy foods increased after improving the nutritional quality of the available products. Product replacement was successful in increasing healthy product sales, while decreasing unhealthy choices. Differently, the addition of a point-of-sales nutrition information service only discouraged choices of less favourable foods without impacting notably on consumer behaviour. Iconographic labels in VMs were able to change only partially consumers’ choices, reducing the purchase of less recommendable products but not substantially enhancing healthier choices. Overall, this study yielded useful information for the implementation of nutrition interventions through VMs, addressing food choices and promoting healthy dietary patterns without limitation of consumers’ freedom. This kind of environmental interventions could lead to improvements in body weight management and consequent health outcomes.

An Exploration of Body Image Perceptions and Education Needs of Military Parents of Preschool Children

ABSTRACTMilitary service members and their families have unique environmental factors that may influence their lifestyle and behaviors. This study, using the social ecological model, was designed to explore the body image perceptions among military family members. Exploratory qualitative focus group interviews were conducted at child development centers on two military bases in the southwest United States. Researchers conducted a total of 8 group discussions with 24 parents. Four themes emerged from the discussions, including: military requirements, partnership, negative fat talk, and encouraging communication. These themes can inform future research about body image perceptions and weight management in military families and guide education programs.

Indeks Jisim Badan (BMI) dan Hubungannya dengan Persepsi Imej serta Kepuasan Berat Badan dalam Kalangan Remaja

This study was conducted to examine the body image perception and body weight satisfaction among teenagers in relation to their Body Mass Index (BMI) trend. Two instruments were administered; the questionnaire, body image perception and the body weight satisfaction among 1200 teenagers. The body mass index (BMI) pola among of 54.41% of the teenagers fall in the normal BMI (18.5-24.9). However, there was an increasing pattern of towards overweight and obese parallel to increasing of ages. This study shows the level of accuracy of the body image perception was highly correlated to the actual BMI, r=0.77, p<0.01. Tehe relationship between body weight satisfaction and BMI is low (r=0.373). To conclude, BMI level of teenagers is at satisfactory level but there is a tendency for them to project for the body weight less than the normal range as prescribed by WHO/UNICEF (1998). Hence, a constant monitoring is indeed required to avoid issues on body weight management such as obesity and under-weight among the teenagers population.

Hypolipidemic effects of S-(+)-linalool and essential oil from Cinnamomum osmophloeum ct. linalool leaves in mice

Cinnamomum osmophloeum (土肉桂 tǔ ròu guì) ct. linalool is one of the chemotypes of the indigenous cinnamon in Taiwan. S-(+)-linalool is the major constituent of leaf essential oil (LEO) of C. osmophloeum ct. linalool. This study aimed to investigate its physiological effects including body weight changes, blood biochemical values, and histopathological changes in mice. The mice were treated with LEO, S-(+)-linalool, and R-(−)-linalool. Results demonstrated similar physiological changes in mice treated with LEO and S-(+)-linalool, but significantly different effects in the body weight, TG, TC and blood glucose of R-(−)-linalool group. S-(+)-linalool-treated mice gained less weight and had significant decrease in blood triglyceride levels. No histopathological changes were observed in livers, kidneys, and spleens of S-(+)-linalool-treated mice. Furthermore, there were no significant differences in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels between S-(+)-linalool-treated mice and the control group. In addition, LEO and S-(+)-linalool significantly inhibited lipid accumulation through down-regulation of 3T3-L1 adipocyte differentiation. Taken together, the results show that LEO and S-(+)-linalool from C. osmophloeum ct. linalool can contribute to body weight management without harmful side effects.

Weight and Veterans' Environments Study (WAVES) I and II: Rationale, Methods, and Cohort Characteristics.

To present the rationale, methods, and cohort characteristics for 2 complementary "big data" studies of residential environment contributions to body weight, metabolic risk, and weight management program participation and effectiveness. Retrospective cohort. Continental United States. A total of 3 261 115 veterans who received Department of Veterans Affairs (VA) health care in 2009 to 2014, including 169 910 weight management program participants and a propensity score-derived comparison group. The VA MOVE! weight management program, an evidence-based lifestyle intervention. Body mass index, metabolic risk measures, and MOVE! participation; residential environmental attributes (eg, food outlet availability and walkability); and MOVE! program characteristics. Descriptive statistics presented on cohort characteristics and environments where they live. Forty-four percent of men and 42.8% of women were obese, whereas 4.9% of men and 9.9% of women engaged in MOVE!. About half of the cohort had at least 1 supermarket within 1 mile of their home, whereas they averaged close to 4 convenience stores (3.6 for men, 3.9 for women) and 8 fast-food restaurants (7.9 for men, 8.2 for women). Forty-one percent of men and 38.6% of women did not have a park, and 35.5% of men and 31.3% of women did not have a commercial fitness facility within 1 mile. Drawing on a large nationwide cohort residing in diverse environments, these studies are poised to significantly inform policy and weight management program design.

Adult obesity management in primary care, 2008-2013.

In the U.S., the occurrence of weight counseling in primary care for patients with obesity decreased by 10% between 1995-1996 and 2007-2008. There have been several national recommendations and policies to improve obesity management since 2008. The purpose of this study was to examine the rates of body mass index (BMI) screening, obesity diagnosis, and weight management counseling in the U.S. from 2008 to 2013. The National Ambulatory Medical Care Survey visit-level data for adults 18 and over with a primary care visit during survey years 2008-2009, 2010-2011, and 2012-2013 was included in the analyses using SAS v9.3. Study outcomes included percent of visits with: BMI screening; obesity diagnosis; and weight counseling. We compared survey years on these outcomes using 2008-2009 as the reference as well as examined patient and practice-level predictors. Analyses were conducted from 2015 to early 2017. Of the total 55,608 adult primary care visits sampled, 14,143 visits (25%) were with patients with obesity. BMI screening significantly increased between 2008-2009 and 2012-2013 from 54% to 73% (OR=1.75, 95% CI 1.28-2.41); however, percent of visits with an obesity diagnosis remained low at <30%. Weight management counseling during visits significantly declined from 33% to 21% between 2008-2009 and 2012-2013 (OR=0.62, 95% CI 0.41-0.92). Despite emerging recommendations and policies, from 2008 to 2013, obesity management in primary care remained suboptimal. Identifying practical strategies to enforce policies and implement evidence-based behavioral treatment in primary care should be a high priority in healthcare reform.

Body weight management and dilemmas of health responsibility for vulnerable groups in the changing Danish welfare state: a comparative case analysis

This article explores how health responsibility in relation to body weight management is institutionally enacted in three welfare institutions in the interplay between traditional ‘social interventionist’ welfare and ‘non-interfering’ neoliberal ideology. The analysis asks how citizens of non-Western origin at different life stages are positioned within, and navigate, opposing ideological value systems, and adapt to, or resist, institutionally constructed ‘health subjectivities’. The cross-case analysis shows that as people grow older, the institutional requirement to adapt to neoliberal norms of individual responsibility increases, but that in all three settings health responsibility is ambiguously distributed and enacted among welfare state agencies and citizens, and that this renders children, youths and parents vulnerable in different ways. We identify how marginalised citizens are constituted by, but also resist, neoliberal health promotion policies as welfare policy moves away from universalism and towards targeting in Denmark, which appears to increase health inequalities along socio-economic and ethnic lines.

Using Digital Health Technology to Prevent and Treat Diabetes.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

Evaluation of antilipolytic, antioxidant and antibacterial activities of selected ferns

In the present study, three ferns were used (Adiantum capillus-veneris Cheilanthes albomarginata and Asplenium pumilum,) to identify their functional compounds to reduce obesity. The methanolic fern-extract (MFE) of these ferns was assessed for anti-bacterial activity by measuring inhibition zones against a panel of pathogenic bacterial strains using the agar diffusion method. MFE at a concentration of 25 μg /ml showed marked anti-bacterial activity against all bacterial strains (6mm to 23mm) zone of inhibition and was greatest against Enterobacter sp (23 mm). Out of these, the MFE of the A. veneris fern extract had the best MIC values of 2.25 μg /ml against S. aureus and Enterobacter sp. respectively. It had an inhibitory concentration (69.9 %) for 2, 2-diphenylpicryl-1-picryl-hydrazyl (DPPH) scavenging activity. The MFE of the A. veriens also possessed good anti-lipolytic activity (76.5%) against a porcine pancreatic lipase (PPL) and cholesterol oxidase inhibition (89%). The hemolytic activity of A. veneris was found to be 27.6% at 6.25 µg/mL of MFE. This result showed that the MFE of A. veriens is not only a potent source of natural anti-oxidants and anti-bacterial activities but also possesses efficient cholesterol degradation and anti-lipolytic activities, which would be beneficial in body weight management.

Diabetes-related weight change in a Canadian First Nation cohort

ABSTRACTThe Canadian First Nations population is disproportionately burdened by diabetes and diabetes complications. Body weight management is purported to be important in the prevention and management of diabetes. In this study, we sought to describe weight change in a First Nation cohort according to diabetes status and management. Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 (baseline) and 2011/2012 (follow-up). The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples, anthropometric, health and demographic data were collected. At baseline, 24.8% (n=41) of the cohort members had diabetes. At follow-up, an additional 20.6% (n=34) developed diabetes. Among all participants with diabetes (long-term and incident cases), 66.6% lost weight between the two study periods. Among only participants with long-term diabetes (>8 years), 31.7% lost >10 kg. HbA1c at baseline, positive change in HbA1c over time, and use of metformin were significantly associated with weight loss ≥5%, independent of age, sex, and BMI at baseline. Further research is needed to better understand if and how diabetes-related weight loss contributes to morbidity and mortality in this First Nation population.

Chickpeas suppress postprandial blood glucose concentration, and appetite and reduce energy intake at the next meal.

The current study was designed to explore the beneficial properties of chickpeas consumption on suppressing appetite, excessive blood glucose excursions, and energy intake (EI) from a subsequent meal. Two caloric preloaded foods, chickpeas, and white bread were compared to water control, fed to healthy female subjects at equal energy density, volume, and available carbohydrate content in two experiments spanning over 60 and 120min. Blood glucose was measured by a portable glucometer and satiety by using a visual analogue scale questionnaire at baseline and every 15 up to 60min in both experiments and then every 30 until 120min in Experiment 2 after the preloads ingestion. A test meal was served at the end of both experiments to calculate EI and percent energy compensation (%EC). The results suggest a reduction of 29-36% in blood glucose concentration, and 83-98% EC after the chickpeas in Experiments 1 and 2 respectively compared to white bread. The average appetite showed a positive association with EI. We conclude that the consumption of chickpeas is beneficial on glycemic control and may help in body weight management through suppressing appetite and energy intake.

Patient and health-care provider perspectives of pregnancy-related health-care provision in Guangdong, China: a qualitative interview-based study

BackgroundPregnancy-related care can reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes. But little is known about the special health-care needs related to pregnancy of these women, or about the gap between these needs and health-care provision in China. We aimed to identify the perceived needs in women with type 1 diabetes and health-care providers for pregnancy-related care. The goal is for the findings to assist in the establishment of optimised management of this population in China. MethodsWe did in-depth interviews, a method widely used in social science to investigate people's attitudes and behaviours. The intended interviewees included women with type 1 diabetes (aged ≥18 years) and health-care providers of both diabetes-related and pregnancy-related disciplines living in Guangdong, China. Written informed consent was obtained from all participants. Selective sampling was used to ensure that the recruited women with type 1 diabetes covering different areas of Guangdong, and were of diverse age, disease duration, marital and child-bearing status, income, and education level; and to ensure that the included health-care providers were from different types of health-care facilities. Transcripts of the interviews were coded into themes by three investigators (SX, SL, and CW) via a thematic framework method and NVIVO (version 10) qualitative software. The recruitment ended when no new themes emerged. Rendered themes of women with type 1 diabetes and health-care providers were compared by thorough discussion within the study team. FindingsThe recruitment started in April, 2015, and ended in June, 2016. 30 women with type 1 diabetes (mean age 26·9, SD 5·7 years) and 35 health-care providers (17 physicians and 18 nurses; 24 from general hospitals and 11 from community health facilities) were included in the study. Pregnant women and health-care providers agreed that pregnancy-related health-care resources were scarce and knowledge of pregnancy-related health care needs of both patients and health-care providers was limited. Both groups agreed that pregnancy-related health care in various forms should be started at the age of maturity (18 years old) and done by well-trained multidisciplinary health-care providers. Both groups acknowledged the importance of peer support in pregnancy-related health care. And both groups agreed on the need for guidelines for planned pregnancy and management of blood glucose and diabetic complications during pregnancy. However, health-care providers reported that bodyweight management, fetal development monitoring, type 1 diabetes-specific screening tests, and postnatal lifestyle should also be emphasised. Health-care providers had a generally positive attitude to outcomes of pregnancy if glycaemic control was satisfactory, whereas patients tended to have a pessimistic perspective. Finally, women with type 1 diabetes expressed great unmet needs: thorough and timely communication with health-care providers, psychological consultation, and type 1 diabetes knowledge in non-diabetician health-care providers. Most health-care providers did not show awareness of these needs, although they were aware of insufficient pregnancy-related knowledge and expressed their intent for further training. InterpretationWomen with type 1 diabetes had various unmet needs for pregnancy-related health care, but the health-care resources were scarce in Guangdong. Both patients and health-care providers had gaps in knowledge of the need for pregnancy-related health care, indicating that further education should be given to patients, and the role of professional and psychosocial support should be enhanced. These findings identify gaps between the needs of women with type 1 diabetes and current health care provision, and would be helpful to guide the establishment of a patient-centered pregnancy-related health care system in Guangdong. FundingNational Health and Family Planning Commission Foundation for public welfare industry research project (201502011), World Diabetes Foundation (WDF14-921), and Sun Yat-Sen University clinical research 5010 program (2007030).

Changes in autonomic nervous system activity, body weight, and percentage fat mass in the first year postpartum and factors regulating the return to pre-pregnancy weight.

BackgroundMany women become obese during pregnancy and the postpartum period. Weight gain and obesity in the general population are often attributed to abnormalities of autonomic nervous system (ANS) activity. The aim of this study was to clarify change in ANS activity, body weight, percentage fat mass (%FM), and body mass index (BMI) and the factors regulating the return to the pre-pregnancy weight in the first year postpartum.MethodsThis study was conducted from 2012 to 2016 at the University Hospital of the Kyoto Prefectural University of Medicine and a nearby obstetrics and gynecology clinic in Japan. Body weight and %FM were measured in 51 women using a dual-frequency body composition measuring device. Heart rate variability and R–R spectral transformation were used as indicators of ANS activity. All parameters were calculated at three postpartum time points. Repeated measure analysis of variance was used for comparisons between measurement times. A multivariable Cox proportional hazards model was conducted to determine factors associated with the return to pre-pregnancy weight.ResultsMean body weight, %FM, and BMI decreased significantly over time after delivery (P < 0.001, P < 0.001, P < 0.001). However, ANS activity did not differ among subjects in the three time points. 25.5 % of subjects had still not returned to their pre-pregnancy body weight by 150–270 days postpartum, and 19.6 % had not by 270–360 days postpartum. Normal-weight obesity (NWO; BMI of 18.5–25 kg/m2 and %FM of ≥30 %) was observed in several subjects at each measurement. The results of analysis using a multivariable Cox proportional hazards model suggest that ANS activity had no significant correlation with the return to pre-pregnancy weight.ConclusionsThe management of body weight and %FM after delivery is considered important. These findings suggest that ANS activity is not associated with the return to pre-pregnancy weight, albeit that sample size was small.

Paradoxical Effects of Fruit on Obesity.

Obesity is exponentially increasing regardless of its preventable characteristics. The current measures for preventing obesity have failed to address the severity and prevalence of obesity, so alternative approaches based on nutritional and diet changes are attracting attention for the treatment of obesity. Fruit contains large amounts of simple sugars (glucose, fructose, sucrose, etc.), which are well known to induce obesity. Thus, considering the amount of simple sugars found in fruit, it is reasonable to expect that their consumption should contribute to obesity rather than weight reduction. However, epidemiological research has consistently shown that most types of fruit have anti-obesity effects. Thus, due to their anti-obesity effects as well as their vitamin and mineral contents, health organizations are suggesting the consumption of fruit for weight reduction purposes. These contradictory characteristics of fruit with respect to human body weight management motivated us to study previous research to understand the contribution of different types of fruit to weight management. In this review article, we analyze and discuss the relationships between fruit and their anti-obesity effects based on numerous possible underlying mechanisms, and we conclude that each type of fruit has different effects on body weight.

Smoking Cessation and Changes in Body Mass Index: Findings From the First Randomized Cessation Trial in a Low-Income Country Setting

In high-income countries, quitting cigarette smoking is associated with weight gain, which can reduce motivation to abstain. Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated. We aimed to determine the post-cessation changes in body mass index (BMI) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting. We performed post hoc analyses of data from 269 smokers who participated in a two-group, parallel-arm, double-blind, placebo-controlled randomized trial of combined nicotine replacement therapy (NRT) and behavioral counseling in primary care clinics in Aleppo, Syria. We used generalized estimating equation modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date. The mean pre-cessation BMI of the sample was 27.9kg/m2 (SD = 5.2). Over 12 months of follow-up, BMI of smoking abstainers averaged 1.8 BMI units (approximately 4.8kg) greater than non-abstainers (p = .012). Throughout the study, greater BMI was associated with being female (p = .048), reporting smoking to control weight (p < .001) and having previously failed to quit due to weight gain (p = .036). Similar to findings from high-income countries, smoking cessation in Syria is associated with weight gain, particularly among women and those who have weight concerns prior to quitting. This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity. This study provides the first evidence regarding post-cessation changes in BMI among smokers who attempt to quit in a low-income country setting. Our findings advance knowledge regarding post-cessation weight gain and offers insight for researchers and clinicians to identify smokers at higher risk of post-cessation weight gain. This information will help in delivering interventions that take into account the prevailing cultural influence on diet and physical activity and will ultimately help in designing future tailored cessation programs in Syria and other low-income countries with similar cultural background and level of development.

Application of Bacillus sp. COX-T3 Cholesterol Oxidase in Reduction of Serum Cholesterol and Body Weight Management in a Murine Model

Application of Bacillus sp. COX-T3 Cholesterol Oxidase in Reduction of Serum Cholesterol and Body Weight Management in a Murine Model

Development of New Methods to Assess the Nutritional Aspects of Cereal Grain Products

Current evidence supporting the health benefits of cereal grains beyond basic nutrition and consumer interest in the area of functional foods have created a need for novel grain-screening methodologies to meet the requirements of each member of the value chain. In response, the methods used in Agriculture and Agri-Food Canada's (AAFC's) multidimensional approach to improving cereal grains have evolved to incorporate an assessment of nutritional quality and functionality during the screening process. These techniques are utilized to support cultivar improvement, develop improved processing strategies for industry, identify potential bioactive components in cereal grains, and investigate overall physiological effects in response to cereal grain consumption, such as glycemic response, cholesterol lowering, body weight management, and gut health. In addition to basic quantification of functional components, novel in vitro and in silico methodologies are being utilized to characterize relevant physicochemical ...

Strong, female and Black: Stereotypes of African Caribbean women's body shape and their effects on clinical encounters.

The aim of this article is to explore how tendencies to stereotype minority ethnic groups intersect with lay discourses about them in ways that can reproduce cultural prejudices and reinforce inequalities in access to services and health outcomes. Drawing upon Black feminist and cultural studies literature, we present a theoretical examination, the stereotypes of the Black woman as 'mammy' and 'matriarch'. We suggest that the influence of these two images is central to understanding the normalisation of the larger Black female body within African Caribbean communities. This representation of excess weight contradicts mainstream negative discourses of large bodies that view it as a form of moral weakness. Seeking to stimulate reflection on how unacknowledged stereotypes may shape clinical encounters, we propose that for Black women, it is the perception of strength, tied into these racial images of 'mammy' and 'matriarch' which may influence when or how health services or advice are both sought by them and offered to them. This has particular significance in relation to how body weight and weight management are/are not talked about in primary care-based interactions and what support Black women are/are not offered. We argue that unintentional bias can have tangible impacts and health outcomes for Black women and possibly other minority ethnic groups.

The role of sugars and sweeteners in food, diet and health: Alternatives for the future

BackgroundThere is currently great interest in reducing the sugar content of foods to control dietary intake and curb obesity rates. Despite a lack of consensus from the scientific literature about the adverse effects of sugars on health, many health professionals and new dietary guidelines place pressure on industry to seek alternative sweetening solutions. Scope and approachWe discuss the nutritional characteristics and health implications of nutritive and non-nutritive sweeteners. The role of traditional sweeteners, which are often overlooked in the debate about sugars and health, is emphasised. Key findings and conclusionsTrends in future sweetener use will likely be influenced by increasing obesity prevalence and consumer demand; however, it is not yet clear which sweetener provides the best solution for this purpose. Given the main concern about sugars is their disproportionate contribution to dietary energy intake, non-nutritive sweeteners (e.g., aspartame, stevia), which provide intense sweetness but minimal caloric value, are increasing in popularity. However, their assumed role in facilitating body weight management is far from established, and many questions remain about their long term effects on energy metabolism and safety. Traditional sweeteners (e.g., maple syrup, honey, carob, and agave) have been safely consumed for generations, and although they contribute to energy intake, these sweeteners tend to have lower glycaemic potency than refined sugars. Moreover, traditional sweeteners contain a plethora of nutrients and bioactive compounds (e.g., polyphenolics) that may be of potential benefit to health.