Alcohol Awareness Week: Understanding alcohol calorie labelling

Alcohol use is well-known to contribute to premature death and preventable diseases, however, how alcohol may contribute to obesity is rarely considered. Alcohol (ethanol) is extremely calorie dense. At about 7 calories per gram  it is almost as high as fats and is considered ‘empty calories’ as it provides energy without nutrition. Around 10% of calories consumed by drinkers are from alcohol.

In the UK, all major food and drink retail businesses are required to include calorie information on menus and labels on products after recent legislation was passed to help combat rising rates of obesity. Paradoxically, alcohol products are exempt from this requirement, despite the fact that there is poor understanding of the caloric content of alcohol. The research we're conducting in the Sustainable Healthy Food Group is aimed at investigating the impact calorie labels might have on alcohol consumption, and particularly calories from alcohol, and how these behavioural changes may impact public health.

Our research is split between the Universities of Oxford and Liverpool, with three main phases exploring the impact of introducing alcohol calorie labels:

1. What is the impact on behaviour in off-trade (supermarket) settings? We will design and compare the efficacy of different alcohol calorie labels: firstly, in a simulated online shopping environment, and subsequently using a field study to compare alcohol purchasing and consumption when exposed to labels or a control condition via an app.
2. What is the impact on behaviour in on-trade (bar & restaurant) settings? We will test alcohol calorie labels in an online simulated bar environment, and then in a ‘bar’ lab.
3. What is the potential impact on morbidity, mortality, and costs to health care services? We will model the potential impact of the effects found in the first two phases on key public health outcomes.

Our project includes public and patient involvement throughout, including working with panels with lived experience of alcohol dependency, or of weight maintenance, as well as the general public. One of the key takeaways from our PPI work is ensuring we can take into account any unintended consequences of alcohol calorie labelling.

We aim to provide evidence on the potential behavioural and health impacts of introducing alcohol calorie labelling. If this looks promising, this could support the introduction of calorie labels on alcoholic products. Calorie labels provide consumers with knowledge at the point of purchase to help them to make an informed decision. This may also give people a better understanding of their caloric intake from alcohol, which may lead to health-positive behavioural changes such as decreased alcohol consumption, or switching to a lower alcohol by volume (ABV) and typically lower calorie alcoholic drink. This may also lead to changes within industry - for example, alcohol manufacturers may reduced the ABV or caloric content of their drinks due to having to publicly display this information.

We received pushback during early PPI and experiment efforts for the inclusion of calorie information due to it being perceived as being the machinations of a ‘nanny state’. While this criticism and similar challenges from public backlash are difficult to circumvent, we feel that calorie information provides useful information to the public, and is a natural extension of the requirement of inclusion of calorie contents already required for food and drink products other than alcohol.

When discussing calorie information there may be steps that can be taken to prevent harm to people with lived experience of disordered eating. To ensure we understand the potential for any harm we have included measures of compensatory eating behaviours throughout our experiments. Compensatory eating (previously insensitively referred to as ‘Drunkorexia’) is a behaviour where food consumption is reduced to justify the consumption of calories from alcohol. We are acutely aware of this maladaptive behaviour, which could be exacerbated by alcohol calorie labelling. This needs to be balanced, however, against there being no ‘healthy’ amount of alcohol to consume – it offers no nutritional benefits, but very real harm to the liver. Investigating these compensatory eating behaviours will allow us to explore if we can limit unintended consequences from alcohol calorie labelling while still leaving room for positive behavioural changes (i.e., reduced consumption).

Our research will hopefully increase awareness of the potential impact of alcohol consumption on obesity, as well as the caloric contents of alcoholic products. It is important to consider during this awareness week that alcohol carries further risks to our health than we might usually consider and be mindful of this when making the decision to drink. Furthermore, I hope if the inclusion of energy labels on alcohol products becomes a requirement in the UK that it empowers members of the public to make informed decisions about their own consumption.