Key points• AlargeproportionofUKadultsareoverweight orobeseandthisnumberisgrowing

• Obesityincreasestheriskofdevelopingmany seriousmedicalconditionsincludingdiabetes, heartdisease,osteoarthritisandsome cancers,andhasfinancialimplicationsforthe NHSandtheUKeconomyasawhole

• Alcoholicdrinksarefrequentlyhighincalories andtheirregularconsumptioncanleadto weightgain

• Ofadultsthatdrink,itisestimatedthatnearly 10%oftheirdailycalorieintakecomesfrom alcohol

Calls to action• TheEuropeanUnionHealthCommissioner anddrinkscompaniestointroducecalorie labellingonallalcoholproducts

• Researchundertakentobetterunderstand therelationshipbetweenalcoholconsumption andhealthyweightinadults,includingthe potentialeffectivenessofusingcalorieand unitlabellingtoreducealcoholconsumption

November 2014

Increasingawarenessof‘invisible’caloriesfromalcohol

BackgroundThepublic’shealthisunderthreatfromanobesityepidemicandharmcausedbyirresponsibleconsumptionofalcohol.Whiletherehasbeenmuchworktolookatthecausesandconsequencesofthetwin-threatsinisolation,lesshasbeendonetolookatthelinksbetweenalcoholandweightgain.InEngland,itisestimatedthat66.6%ofmenand57.2%ofwomenareclassedasoverweight(ofwhom24.4%ofmenand25.1%ofwomenareobese).1Beingoverweightorobeseincreasestheriskofdevelopingarangeofseriousillnesses,includingtype2diabetes,highbloodpressure,musculoskeletalproblems,heartdisease,strokeandsomecancers.2OverweightandobesityandtheirassociatedhealthproblemshaveasignificanteconomicimpactontheNHS.Inadditiontodirecthealthcarecosts,obesityhasfinancialimplicationsforthewidereconomythrough,forexample,lossofproductivityandbenefitpayments.3

Excessiveconsumptionofalcoholhasbeenlinkedtodamagetohealth.Inadditiontoshorttermhealthconsequencessuchasinjuries,alcoholpoisoningandriskybehaviour,excessivealcoholconsumptionisalsolinkedtohighbloodpressure,liverdisease,cancersandmentalhealthproblems,includingdepressionandanxiety.4

Whileariseinsedentarylifestyleandoverconsumptionoffoodshighinfatandsugarhavebeenattributedtothegrowthinthenation’swaistlines,relativelylittleresearchhasbeenconductedintothespecificcontributionalcoholconsumptionplays.

Therecommendeddailycalorieintakeforadultsisapproximately2,500kcalformenand2,000kcalforwomen.5

Oneunitofalcoholcontainseightgramsor10mlofalcoholwhichprovides56calories(kcal).CurrentUKgovernment

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guidelinesforhealthandwellbeingsuggestthatwomenshouldnotdrinkmorethan2-3unitseveryday(onepintofbeeroronemediumglassofwine);menshouldnotdrinkmorethan3-4unitseveryday(oneandahalfpintsofbeeroronelargeglassofwine).6Itisvitalthatindividualsaresupportednottodrinkmorethanisrecommendedintheseguidelines.

Recentresearchdemonstratedthat11%ofadultsweredeemedtobefrequentdrinkers(havingdrunkalcoholonatleastfivedaysintheweekbeforebeinginterviewed)andofthosethathaddrunkinthepreviousweek,29%ofmenand21%ofwomenwereclassedasheavydrinkers(havingdrunkmorethaneightunitsformenandsixforwomenontheirheaviestdrinkingday–doubletherecommendeddailyintake).7

Therelationshipbetweenalcoholandobesityiscomplex.Alcoholcannotbestoredinthebody,howeveritsconversiontoacetateintheliverandsubsequentreleaseintothebloodstreaminhibitstheamountoffatthebodyburns.8Conversely,alcoholappearstoincreaseenergyexpenditurewithinthebody.9Despitethiscomplexity,becausealcoholicdrinksarenotsolelycomprisedofalcohol,otherfactorsneedtobeconsidered,suchastheirsugarcontent.Whileaunitofalcoholis56calories,aunitof13%ABVwineisaround70calories(a175mlglassis2.3unitsandover160calories).Aunitofanalcopopmaybeover150calories(a275mlbottlemaycontainmorethan170calories)andaunitof4%ABVbeerwillcontainaround80calories(andapintover180calories).10Spiritsmayalsofrequentlybeaccompaniedbysoftdrinks(mixers)containingsugar.Amongadultswhodrink,itisestimatedthatnearly10%oftheirdailycalorieintaketypicallycomesfromalcohol.11Alcoholdoesn’tjustcontributetopotentialweightgainthroughthecaloriescontainedwithintheproduct,butalsothroughitsaffectonhungerlevelsandfoodpreferences.Thestimulatoryeffectofalcoholconsumptiononfoodintakemaybeasaresultofstimulationorinhibitionofappetiteregulatoryhormones12andenhancingtheshorttermeffectsoffood.13

Thereisevidencethatheavydrinkers(drinkingfourormoredrinksperday)areatagreaterriskofobesitythanmoderateornon-drinkers.Theoddsofbeingoverweightorobesearealsosignificantlyhigheramongbingedrinkersthanamongthosewhoconsumethesameamountofalcoholovermultiplesessions.14Weightgainfromdrinkingalcoholisalsogreaterinindividualswhoarealreadyoverweightorobeseandthereareindividualdifferencesintheimpactofalcoholconsumptiononweight.15Drinkersdependentonalcohol,however,duetothepropensitytosubstitutealcoholformeals,mayexperienceweightloss.16

Nearlyhalfofallalcoholsoldispurchasedfromsupermarketsandoff-licenses.17

RSPHsupportsanumberofmeasurestopromoteresponsibledrinking.Minimumunitpricingisaneffectiveandevidence-basedapproachtoreducingalcoholconsumptionanditsassociatedharms18,19andwestronglysupportitsimplementationacrosstheUK.

However,wealsobelievethatmoreneedstobedonetohelpsupportthepublicinmoderatingtheirdrinking.Whilemuchofthefocusonlabellingofalcoholhascentredaroundunits,giventhatcaloriesarefairlywellunderstoodbythepublic,wewouldarguethatcalorielabellingalongsideunitlabellingwouldhelpfurthersupportthepublictomakeinformedchoicesabouttheiralcoholconsumption,andultimately,moderatetheirdrinking.

AsurveycommissionedbyRSPHof2117UKadultsinOctober2014showedthatover80%ofpeopledidnotknoworunderestimatedthenumberofcaloriesinalargeglassofwine;over60%ofpeopledidnotknoworunderestimatedthenumberofcaloriesinapintoflager.Whilewomenwerelesslikelythanmentostatethattheydidnotknowthenumberofcaloriesinthedrink,therewaslittledifferenceinthenumberofmenandwomenwhocorrectlyidentifiedthecaloriecontent.

RSPHbelievesthatgivenalcoholprovidesapproximately10%ofenergyintakeforadultswhodrink,publicconfusionaboutthecaloriescontainedwithinalcoholicdrinks,andtheusebyconsumersofcalorielabellingonfoodproductstomakeinformedchoices,nutritionalinformationincludingcaloriecontentshouldbeextendedtoalcoholicbeverages.Despitetheircaloriecontent,alcoholicbeveragesarecurrentlynotrecognisedasfoodandarethereforeexemptedfromtherequirementsofnormalnutritionallabelling.Thisaddstothegenerallackofpublicawarenessaboutthecaloriecontentofalcoholicdrinks.

What are the RSPH calling for?• EuropeanUnionHealthCommissionerand drinks companies to introduce calorie labelling on all alcohol products

CurrentEuropeanlegislationexemptsalcoholicbeverages(morethan1.2%byvolume)fromtheobligationtolistitsingredientsandprovidenutritioninformation.AspartofaPublicHealthResponsibilityDealagreedwiththeGovernmentinMarch2011,UKmajoralcoholbeveragemanufacturersandretailerspledgedtoimplementahealthlabellingschemewhichincludedinformationabouttheunitalcoholcontent,theChiefMedicalOfficer’sdailyguidelinesforlowerriskconsumptionandpregnancywarning,tobetterinformconsumersaboutresponsibledrinking.20Wewouldarguethatinadditiontothisinformation,caloriecontentshouldbeincludedwithsomeurgency.

ThenewlyappointedEuropeanUnionHealthCommissioner,VytenisAndrutakitis,iscurrentlyleadingaconsultationintoEUregulationonalcohollabelling.WecallfortheEUtomakeaswiftdecisioninfavourofincludingbothunitandcalorielabellingtoensurethatconsumersareabletomakeinformeddecisionsaboutthedrinkstheypurchase.IrrespectiveoftheEUdecisionhowever,wecallfordrinksmanufacturerstovoluntarilyincludecalorieinformationontheirdrinks’labels.

OurrecentresearchofUKresidentssuggeststhat67%ofpeoplesupporttheadditionofcalorielabelsonpackaging

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ofalcoholicdrinksandonly3%ofpeopleopposethem(theremainingindividualshavenoopinioneitherway).

Calorielabelsshouldbedisplayedprominentlyinlargefont,andshouldbepresentonproductsandpotentiallyonbeerpumps,bar/pubmenusandbeermats.Everyoneshouldbeabletoseeboththenumberofunitsandthenumberofcaloriesavailableintheirdrinkbeforepurchase,whetherinashoporapuborrestaurant.

• Researchundertakentobetterunderstand the effectiveness of using calorie and unit labelling to reduce excess alcohol consumption

Thereisevidencethatprovidingcalorieinformationonfoodcansupportindividualstomakehealthierfoodchoiceswhereindividualshavereadandunderstoodtheinformation.21Howevertherehasbeenlittleresearchontheeffectonbehaviourofincludingcalorielabellingonalcoholicdrinks.Wecallforresearchtostrengthentheargumentforcalorielabellingofalcoholinpubsandbars,aswellassupermarketsandotherpointsofsale.Thisresearchshouldconsiderageandgenderastheseimpactuponkeyaspectsofhealthliteracy,bodyimageandphysiology.Therealsoneedstobeongoingresearchintotheimpactofalcoholonobesityandthedrinkingbehavioursthatputindividualsatgreatestriskofexcessweightgain.

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