title: Dietitian perceptions of low-calorie sweeteners.
abstract: BACKGROUND
  Lowering energy (calorie) intake is essential in managing a healthy weight. One method of doing this is substituting sugar with low/no-calorie sweeteners. The safety of sweeteners has been debated, but little is known about how they are perceived by professionals responsible for weight management advice. We sought to explore dietitian perceptions of sweeteners and to identify the practical advice they provide about them.
  
  
  METHODS
  We collected data in France, Germany, Hungary, Portugal and the United Kingdom. We used face-to-face interviews and a novel online tool designed to engage people with online content in a way that approximates everyday processes of making sense of information.
  
  
  RESULTS
  We identified four approaches to sweeteners that dietitians took: (1) sweeteners should not be used, (2) they should be limited and used primarily as a transitional product, (3) sweetener use was decided by the client and (4) sweeteners should be recommended or at least allowed. Where dietitians are reticent to recommend sweeteners this is because they feel it is important for consumers to reduce their attachment to sweet tastes and of evidence linking the consumption of sweeteners to increased appetite. There is also uncertainty about the possible negative health effects of sweeteners.
  
  
  CONCLUSIONS
  Dietitians' perceptions about sweeteners are uncertain, ambivalent and divergent, sometimes explicitly being linked to fears about adverse health effects. Clear and authoritative guidance is required on scientific evidence around sweeteners as well as the ways in which they can be used in dietetic practice.
authors.affiliation: 1 Department of Psychology, University of Bath, Bath, United Kingdom m.harricharan@bath.ac.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Harricharan
authors.affiliation: 2 European Food Information Council, Brussels, Belgium.
authors.forename: Josephine
authors.initials: J
authors.lastname: Wills
authors.affiliation: 3 European Food Information Council, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Metzger
authors.affiliation: 4 School of Health Professions, Plymouth University, Plymouth, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: de Looy
authors.affiliation: 5 Department of Psychology, University of Bath, Bath, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Barnett
mesh_terms: D001291:Attitude of Health Personnel; D004046:Dietetics; D002149:Energy Intake; D005602:France; D005858:Germany; D006801:Humans; D006814:Hungary; D064686:Nutritionists; D011174:Portugal; D013549:Sweetening Agents; D006113:United Kingdom
chemical_list: D013549:Sweetening Agents