Week 5-The Association between eating and drinking behaviour

Question 1

How is alcohol a risk factor for weight gain?

Answer 1

■ Alcohol has an energy density of 7.1 kcal per gram
– Second most energy-dense macronutrient only to fat (9 kcal per gram).
– Frequent consumption of alcohol may therefore lead to weight gain if this is not compensated for.

■ In addition to alcohol’s high energy density, alcohol-induced increases food intake can produce an even greater caloric surplus.

Question 2

What is the link between acute alcohol consumption and total energy intake? (Kwok et al., 2019)

Answer 2

-Total energy intake = calories from alcohol consumed AND food consumed.

-alcohol consumption increases total energy intake.

Question 3

What is the link between acute alcohol consumption and food energy intake? (Kwok et al., 2019)

Answer 3

Increased food energy intake with alcohol consumption.

Question 4

What are 2 prolonged pathways by which alcohol can increase weight?

Answer 4

Increased energy intake (from the alcohol itself) + Increased food intake when in an intoxicated state = Risk of alcohol-induced
weight gain.

Question 5

What are some ways in which alcohol consumption can affect food intake?

Answer 5

■ Increase the reward value and craving towards food (Gough et al., 2021)

■ Impair inhibitory control (Christiansen et al., 2016)

■ Hyperactivity of Agrp neurons in the hypothalamus (an important part of the brain’s feeding circuit which often flips the brain into hunger mode) (Cains et al., 2017)=flipped into chronic hunger

■ Suppresses/stimulates hormones implicated in appetite control (see Traversy & Chaput, 2015 for review)

Question 6

What is Gough et al’s (2021) study involving whether alcohol can increase the reward value and craving of foods?

Answer 6

■ Using a within-subjects design, 84 participants attended two sessions, one
where they consumed an alcoholic drink (0.6 g/kg) and another where they consumed an alcohol-free placebo (i.e., gave them a dosage of alcohol dependent on body weight).

■ Measures of snack urge ratings (including desire to consume) were measured before and after consumption of the test drink.

■ A measure of attentional bias was also taken (using a modified stroop task).
– This measured food-related attention bias (in theory greater attention=greater desire to consume food).

■ Comparison was food-related attention bias after consuming alcohol vs after
consuming the placebo drink.

Question 7

What were Gough et al’s (2021) study findings?

Answer 7

■ Alcohol consumption of a moderate alcohol dose (0.6 g/kg) does increase food intake and attentional bias towards food.

■ Importantly, we also tested the effect of a lower dose of alcohol (0.3 g/kg).
– This did not affect food intake or attentional bias of food.
– A dose-dependent response? I.e., does a certain threshold of alcohol need to be consumed before we see changes in eating behaviour? Why is this the case?

Question 8

What was Christiansen et al’s (2016) study relating to if alcohol reduces inhibitory control?

Answer 8

■ Recruited 60 female participants who consumed either an alcohol-free placebo or an alcoholic drink (0.6 g/kg).

■ After consuming the drink, participants completed a Stroop task (measuring inhibitory control) (given colour words in different colours and asked to ignore the actual colour and just say the colour the word says) and were allowed to freely consume cookies for 15 minutes.

Question 9

What was Christiansen et al’s (2016) findings?

Answer 9

■ Cookie calorie intake was greater in the alcohol condition. Stroop reaction time was greater in the alcohol condition (indicative of poorer inhibitory control).

■ Findings also showed that Stroop task performance mediated the effect of drink condition on cookies consumed (i.e., partially explain by impaired inhibitory control).

Question 10

What is the importance of goals and
cognitive processes in eating behaviour?

Answer 10

■ Cognitive processes, such as dietary goals (e.g., desire to avoid weight gain) determine eating behaviour.

■ These processes can interact with homeostatic processes but can
also override behavioural impulses.
– E.g., alcohol consumption produces a greater desire to consume food, however initiation of this action will partially depend on an individuals goal.

■ Christiansen et al. (2016) also investigated whether dietary restraint (concerns of weight gain) may moderate the mediation
effect.

Question 11

What were Christiansen et al’s (2016) findings for the mediated effect of intentions on eating behaviour?

Answer 11

■ The mediation effect was significant for those with low and medium dietary restraint, but not high dietary restraint.

■ This suggests that an individuals cognitive goals (e.g., avoiding weight gain) can override the effect of alcohol consumption on food intake.

Question 12

What is the Dual-Process Model of Eating
Behaviour?

Answer 12

■ From the reviewed research, we can see that alcohol increases food reward (Gough et al., 2021) and can impair inhibitory control (Christiansen et al., 2016).

■ (Over)eating in humans is argued to occur in part due to increased food reward and reduced inhibitory control.

■ Interaction between food reward and inhibitory control predicts short-term food intake (Appelhans et al., 2011) and also changed in weight.

Dual=1. Food Reward 2. Inhibitory Control

Question 13

What evidence is there of reward and inhibitory control predicting BMI change? (Meule & Platte, 2016)

Answer 13

-High motor impulsivity (i.e., poor inhibitory control) and high attentional bias show the highest change in BMI over the course of a time period.

Question 14

What Cross-sectional evidence is there for drinking behaviour and weight? (Traversy & Chaput, 2015)

Answer 14

■Associations between drinking behaviour and weight outcomes are mixed (Traversy & Chaput, 2015)
– In both men and women:

■ No association : Four studies (men); Two studies (women)

■ Positive association: Three studies (men)

■ Negative association: Two studies (men); Six studies (women)

■ J-shaped pattern (if we imagine we have alcohol consumption on the x axis and BMI on the y axis, people who consume no alcohol have a moderate BMI, those who drank the highest amount had the highest BMIs): Five studies (men); Four studies (women)

■ Positive association (binge drinking only): Four studies (men); Three studies (women)

■ Frequency negatively associated, but intensity positively: Three studies (men); One study (women)

Question 15

What Longitudinal evidence is there for drinking behaviour and weight? (Traversy & Chaput, 2015)

Answer 15

– In both men and women:
■ No association : Six studies (men); Seven studies (women)

■ Weight gain: Two studies (men); Three studies (women)

■ Increases in drinking positively associated:
Three studies (men); Two studies (women)

■ Positive association only in heavy drinking: Five studies (men); Four studies (women)

-Therefore, there are very mixed and contradicting results

Question 16

Why are the findings between drinking behaviour and weight inconsistent?

Answer 16

■ The type of drinking behaviour seems to matter
– This can be split into drinking frequency and intensity

■ Drinking frequency – how regularly someone drinks

■ Drinking intensity – how much someone drinks during a drinking episode
– Drinking intensity seems to be a stronger predictor of weight gain (Traversy & Chaput, 2015).

■ Think back to Gough et al (2021)! -
consistent with a dose-dependent
effect of alcohol.

■ Confounding variables
– Compensatory behaviours (e.g., caloric restriction, physical activity)

■ Many studies do not control for these, but individual may use these to maintain energy balance.

Question 17

What is the link between Compensatory behaviours and Drinking behaviours?

Answer 17

■ Physical activity has been shown to positively correlate with alcohol consumption (Piazza-Gardner & Barry, 2012; Conroy et al., 2015).

■ Females who use exercise as a compensatory mechanism consume higher amounts of alcohol (Buchholz & Crowther, 2014).

■ Other compensatory behaviours may be at play as well.

Question 18

What evidence is there for people’s knowledge of energy content of
alcoholic drinks? (Robinson et al., 2021)

Answer 18

■ Robinson et al. (2021) – conducted systematic review of studies examining consumer knowledge of energy content of alcoholic drinks.

■ Across eight studies, the proportion of inaccurate calorie estimation responses ranged from 38% - 83% of participants.

■ Six studies also measured the direction of inaccuracy (i.e., measured whether incorrect responses were an underestimation or
overestimation).

■ Four out of the six studies found that overestimation was most common.

■ Bottom line: majority of people are unable to accurately estimate calorie content of alcoholic drinks.

Question 19

How do consumers respond to
calorie labelling of alcohol products? (Robinson et al., 2021)

Answer 19

■ Robinson et al. (2021) also reviewed experiments which have measured the effect of energy labelling on consumer behaviour.

■ One study (Maynard et al., 2018) found that alcohol calorie labelling did not affect alcohol consumption.

■ Most studies, however, measured intended consumption (rather than actual consumption).
– This is an issue – there is an ‘intention-behaviour’ gap – what one intends to do, does not always equate to what one actually does.

■ Collectively, six experimental studies did not find evidence to show that calorie labelling affects consumer behaviour (both in terms of intention and consumption).

Question 20

What is the use of Physical Activity
Equivalent (PACE) Labels?

Answer 20

■ Since the Robinson et al. (2021) review, Robinson, Smith, and Jones (2022) investigated the effect of presenting PACE labels on alcoholic drinks, on drinking intentions.

-It’s how much physical work you need to do to burn off the calories of the alcohol

Robinson et al’s (2022) findings:
-Calorie labelling does affect intention AND may be most affective in changing attention behaviours also.

Question 21

True or False: Some countries are beginning to adopt mandatory alcohol calorie labelling

Answer 21

True

Question 22

What are the Potential effects of calorie
labelling of alcohol drinks? (Robinson et al., 2023)

Answer 22

3 potential effects:
1. Could prime an individual to think about calories later developing healthier behaviours (i.e., change frequency and type of alcohol consumed).

2. Creates awareness there is more calories than expected (change to more non-alcoholic drinks).
3. Creates awareness there is less calories than expected (change to amount of energy expended from physical activity i.e., less)

Question 23

What should future research include in calorie labelling?

Answer 23

■To date, most studies have focused on
intentions rather than actual consumption.

■Although these are correlated, there is a
large intention-behaviour gap.

■More research needs to be conducted which measures actual consumption behaviour.

Question 24

True or False: More and more young people are abstaining from alcohol

Answer 24

True (specifically 16-24 year olds) BUT young drinkers are most likely to binge drink.

Question 25

What’s the ‘Freshman 5’? (Vella-Zarb et al., 2009)

Answer 25

-Freshman 15 is the theory that year 1 students gain 15lbs throughout the year

-But this is what the media says and its actually rather more 5lbs

Question 26

Are young adult drinkers at greater risk of weight gain?

Answer 26

■Young adult drinkers most likely age group
to binge drink.

■Binge drinking patterns may pose a greater risk to weight gain (Traversy & Chaput, 2015).

Question 27

What is the role of alcohol between weight and young adults?

Answer 27

■ Like for the general population, it’s a mixed bag of findings.

■ Some studies found an association between alcohol consumption and weight (Adams & Rini, 2007; Bodenlos et al., 2015; Deforche et al., 2015; de Vos et al., 2015; Economos et al., 2008; Lloyd-Richardson et
al., 2008; Zagorsky & Smith, 2011).

■ Other studies have found no association (Deliens et al., 2013; Fazzino et al., 2019; Kasparek et al., 2008; Pliner & Saunders et al., 2008; Pope et al., 2017).

■ Discrepancy could be due to the measure of alcohol consumption – many of the studies which find an effect used ‘drinking intensity’ as the measure of alcohol consumption.

Question 28

Is Heavy drinking patterns associated with greater BMI in young adults?

Answer 28

■ Albani et al. (2018) – used cross-sectional data of 18-25 year olds from the 2008-2014 Health Survey for England and the Scottish Health Survey (n = 7691).

■ Looked to see whether energy consumed on someone’s heaviest day of drinking in the past week was associated with BMI.

-Lowest level of alcohol=moderate BMI WHEREAS higher level of alcohol=higher BMI

■ Compensatory behaviours in terms of caloric restriction may be particularly pronounced in young adults.

Question 29

What is Drunkorexia?

Answer 29

–Diet-related behaviour focused on reducing the number of calories consumed while increasing the effects of alcohol.

– Not an official medical term, but is characterised by the following
behaviours:
■ Purging, restriction of eating prior to drinking, high levels of exercise, use of
diuretics.

■ Believed to occur in part due to particular western cultural values which focus on physique and use of alcohol in social situations.
– Compensatory behaviours have been shown to occur in undergraduates, one study reporting as high as 46% of respondents (Giles et al., 2009).

Question 30

What is the Role of weight control motives
and drunkorexia?

Answer 30

■Young adults showed heightened concern of weight and/or desire to lose weight.

■Shown to increase from adolescents to
young adulthood (Sweeting et al., 2016).

■Weight control behaviours also believed to
be greater in females (Cummings et al., 2017).

Question 31

What is the link between Drunkorexia and young adults?

Answer 31

■ Eisenberg and Fitz (2014) – sex difference in drunkorexia explained by weight concern motives (women had greater weight concerns and drunkorexia behaviours)

■ The Effect of weight control motives on
drunkorexia differs between heavier and
lighter drinkers

Question 32

What are some others predictors of Drunkorexia?

Answer 32

■ Hill and Lego (2019) examined the role of body esteem and sensation seeking in
drunkorexia behaviours in University undergraduates.
– Body esteem = a domain of self-esteem which relates to perceptions and attitudes towards ones weight and appearance.
– Sensation seeking = propensity to seek out novel and/or varied experiences.

■ Used the Compensatory Eating and Behaviours in Response to Alcohol Consumption Scale – consists of four subscales
– Alcohol effects (behaviours which enhance effects of alcohol)
– Purging (bulimic-like behaviours)
– Dietary restraint and Exercise (reducing food intake/increasing energy expenditure)
– Restriction (skipping meals or not eating for a day)

Question 33

What were Hill & Lego’s (2019) findings?

Answer 33

-Those who are high sensation seeking are more likely to display these alcohol effect behaviours i.e, change eating behaviours to enhance eating

-Sensation seeking is a predictor of bullimia

-All 3 variables are a predictor of restricted diet and exercise and restriction behaviours

Question 34

What is the link between alcohol calorie labelling and young adults?

Answer 34

■ Maynard et al. (2018) investigated the effect of alcohol unit and calorie information on beer consumed.

■ Also took qualitative data to record reactions to calorie labelling

■ Qualitative data revealed that with calorie labelling, some individuals may reduce food consumption before a drinking episode
– “In calorie-conscious people, I believe the number of calories would affect the amount they eat during the day (in anticipation of the night’s drinking), but not on the specific drinks they choose (Female, 19)”

■ In young adults, calorie labelling may produce unintended consequences,
related to drunkorexia.

Question 35

What are the Social and cultural influences of alcohol consumption?

Answer 35

■Alcohol in many cultures and social groups is a source of pleasure and is consumed within social contexts.

■Within young adults this is particularly true – drinking and eating are often opportunities for individuals to socialise, where social norms can influence behaviour.

■These social influences may reinforce particular types of eating and drinking patterns.

Question 36

What was found in Scott et al’s (2020) study?

Answer 36

■ Qualitative study interviewing 18-25-year-olds in North-East England, exploring the links between unhealthy eating behaviour and heavy alcohol use.

Three themes identified:
– 1) How food and alcohol consumption is linked
– 2) Influences upon linked eating and drinking behaviours
– 3) Young adults’ feelings and concerns about linked eating and drinking behaviours

Question 37

What was found in Scott et al’s (2020) study? Theme 1: How food and alcohol consumption is linked

Answer 37

Three subthemes:
– Feeling that eating and drinking linked
for themselves and peers (i.e., they just go together)
– Changes to eating behaviour during/after
drinking alcohol (e.g., wasting money on a takeaway whilst drunk)
– Change of eating behaviour the day after
drinking (e.g., not wanting to eat a salad whilst hungover rather a chippy)

Question 38

What was found in Scott et al’s (2020) study? Theme 2: Influences upon linked eating and drinking behaviours

Answer 38

Two subthemes:
– Behaviours influenced by costs, resources, access (e.g., no healthy places on a night out)
– Influence of living situation on eating and drinking (e.g., if your friends buy takeaways all the time then you probably do too as a result)

Question 39

What was found in Scott et al’s (2020) study? Theme 3: Young adults’ feelings and concerns about linked eating and drinking behaviours

Answer 39

Two subthemes:
– Risks of alcohol and food consumption
relating to weight, appearance, social
status (e.g., restrict unhealthy foods to fit alcohol in diet)
– Lack of consideration of calories/alcohol units when intoxicated (e.g., exercising often but then just going off the rails)

Question 40

What is a summary of Scott et al’s (2020) study?

Answer 40

■ Scott et al. identifies several themes linking eating and drinking behaviours.

■ Many of these may highlight towards an increase in calories consumed during and after a drinking episode.

■ Identifies potential compensatory behaviours (e.g., meal skipping, performing of physical activity).

■ Also identifies how these behaviours are important culture elements to social life for some young adults within this age bracket.