College students' compensatory eating and behaviors in response to alcohol consumption

Gender orientation and alcohol-related weight control behavior among male and female college students

OBJECTIVE

We examine weight control behavior used to (a) compensate for caloric content of heavy alcohol use; and (b) enhance the psychoactive effects of alcohol among college students. We evaluate the role of gender orientation and sex.

PARTICIPANTS

Participants completed an online survey (N = 651; 59.9% women; 40.1% men).

METHOD

Weight control behavior was assessed via the Compensatory-Eating-and-Behaviors-in Response-to-Alcohol-Consumption-Scale. Control variables included sex, race/ethnicity, age, and depressive symptoms. Gender orientation was measured by the Bem Sex Role Inventory. The prevalence and probability of alcohol-related weight control behavior using ordinal logistic regression are reported.

RESULTS

Men and women do not significantly differ in compensatory-weight-control-behavior. However, regression models suggest that recent binge drinking, other substance use, and masculine orientation are positively associated with alcohol-related weight control behavior.

CONCLUSIONS

Sex was not a robust predictor of weight control behavior. Masculine orientation should be considered a possible risk factor for these behaviors and considered when designing prevention and intervention strategies.

Alcohol use and strenuous physical activity in college students: A longitudinal test of 2 explanatory models of health behavior

OBJECTIVE

To help clarify the effect of gender on the bidirectional relationship between alcohol use and strenuous physical activity in college students.

PARTICIPANTS

Five hundred twenty-four (52% female) college students recruited in August 2008 and 2009 and followed up in April 2009 and April 2011, respectively.

METHODS

Participants reported their alcohol use and strenuous physical activity on 2 occasions (baseline and follow-up) spaced approximately 1 or 2 years apart.

RESULTS

For females, alcohol use quantity at baseline was associated with increased strenuous physical activity at 1- and 2-year follow-ups, and alcohol use frequency at baseline was associated with decreased strenuous physical activity at 2-year follow-up. For males, alcohol use frequency at baseline predicted decreased strenuous physical activity at 1-year follow-up.

CONCLUSIONS

Gender differences may be explained from an eating disorders perspective such that women use physical activity as a compensatory strategy to combat potential weight gain from calories consumed during alcohol use.

The Influence of Mixers Containing Artificial Sweetener or Different Doses of Carbohydrate on Breath Alcohol Responses in Females

BACKGROUND

Breath alcohol responses may be affected by the presence of carbohydrate (CHO) in a beverage. This study investigated the impact of consuming alcohol with mixers containing various doses of CHO or an artificial sweetener on breath alcohol concentration (BrAC), ratings of intoxication and impairment, and cognitive performance in females.

METHODS

Twenty-six females (age 25.1 ± 0.7 years, mean ± standard deviation) completed a crossover study involving 4 trials. A dose of alcohol was consumed in each trial mixed with water (W), artificial sweetener (150 ± 1 mg aspartame [AS]), or CHO (15 g sucrose [15CHO] and 50 g sucrose [50CHO]). BrAC was sampled for 210 minutes following beverage ingestion and analyzed for peak BrAC and other parameters using WinNonlin noncompartmental pharmacokinetic modeling (c_max , t_max , area under the curve to the last measured time point [AUC_last ]). An objective measure of cognitive performance was assessed using a 4-choice reaction time (CRT) task. Estimation of BrAC, self-reported ratings of intoxication, and willingness to drive were recorded.

RESULTS

Mean peak BrAC was reduced in a dose-response manner when alcohol was consumed with CHO compared to both W and AS treatments (W: 0.054 ± 0.015%, AS: 0.052 ± 0.011%, 15CHO: 0.049 ± 0.008%, 50CHO: 0.038 ± 0.007%). No difference in peak BrAC was observed between W and AS treatments. WinNonlin parameters revealed significant differences in c_max and AUC_last (W: 4.80 ± 1.12 g/dl/h, AS: 4.61 ± 0.92 g/dl/h, 15CHO: 4.10 ± 0.86 g/dl/h, 50CHO: 3.11 ± 0.58 g/dL/h) when CHO-containing beverages were consumed compared to W and AS treatments. No difference in t_max or CRT was observed between treatments. Participants were able to detect subtle differences in peak BrAC and reported greater ability to drive after consuming 50CHO compared to W. However, participant's willingness to drive and CRT did not differ between treatments.

CONCLUSIONS

Consuming alcohol with CHO-containing mixers attenuates peak BrAC and reduces total alcohol exposure in a dose-response manner compared to drinks containing artificial sweetener or no additives. The effect of adding CHO to alcoholic beverages may translate to reduced risk of alcohol-related harms.

Mixing alcohol with artificially sweetened beverages: Prevalence and correlates among college students

Mixing alcohol with diet beverages, as compared to mixing the same amount of alcohol with a regular beverage, is associated with greater intoxication. This may occur because diet mixers increase alcohol absorption rates. Thus, it is plausible that the use of diet mixers may increase the risk of alcohol-related harms. The current study sought to (1) determine the rate/frequency of use in among college students, (2) examine the relationship between mixing alcohol with diet beverages and alcohol-related problems, above typical alcohol use and sensation seeking, and (3) explore key traits (gender, restricting food while drinking, and body mass index [BMI]) that may characterize users. Participants were 686 (73% female) undergraduate students who completed self-reports of alcohol use (including diet mixer use), alcohol-related problems, eating behaviors while drinking, sensation seeking, and demographic information. Results revealed that about 36% of the sample reported consuming alcohol with diet mixers, and users typically consumed this beverage at least once a month. Students who reported mixing alcohol with diet beverages experienced more alcohol-related problems. And, the more frequently one consumed this beverage, the more problems were reported. These associations were found after controlling for typical level of alcohol use and sensation seeking. No differences were observed between user-status on gender, eating behaviors while drinking, and BMI. Our findings suggest that mixing alcohol with diet beverages could be a risk factor for experiencing more alcohol-related harms. Further research is needed to understand this relationship, as it may help guide intervening efforts aimed to reduce alcohol-related risks.

The Relationship Between Physical Activity and Alcohol Use Among Adults in the United States

OBJECTIVE

To synthesize published literature that has tested the relationship between physical activity and alcohol use.

DATA SOURCE

A systematic review of literature published between January 2005 and May 2015 was conducted by searching the databases: PsychInfo, Medline, and Pubmed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria: must have tested for the relationship between physical activity and alcohol use; used adult samples within the United States.

EXCLUSION CRITERIA

utilized samples from outside the United States, adolescents, or alcohol dependent and heavy drinkers.

DATA EXTRACTION

Data were extracted from studies that achieved a quality score of 4 or greater. The following information was recorded for each study: sample characteristics, the variable that served as the predictor, study design, covariates included in analyses, and the direction/nature of the relationship.

DATA SYNTHESIS

The search captured 1036 unique articles, 16 of which were included in the final systematic review.

RESULTS

Nearly 88% of the studies with college students and 75% of studies with nonstudent adults reported a positive relationship between physical activity and alcohol use.

CONCLUSION

Research published in the past decade implies a positive relationship between physical activity and alcohol use. Findings have important implications for the design of health promotion programs targeting physical activity and alcohol use.

Is "drunkorexia" an eating disorder, substance use disorder, or both?

Researchers have identified a specific behavior pattern labeled "drunkorexia" to describe recurrent inappropriate compensatory behaviors (e.g., fasting and self-induced vomiting) to avoid weight gain from consuming alcohol (referred to as ICB-WGA). Several studies have investigated the prevalence of these behaviors among college students, but few have tested whether this behavior pattern is more strongly related to substance use or disordered eating, which may have future implications for eating disorder and substance abuse research fields. The aim of this project was to test: (1) whether disordered eating or alcohol use adds incremental validity to the prediction of ICB-WGA when controlling for the other variable and (2) the effect of sex on ICB-WGA. College participants (N=579; 53% female) completed the Eating Pathology Symptoms Inventory (EPSI), the Alcohol Use Disorders Identification Test (AUDIT), and several questions designed to measure ICB-WGA. Results indicated that EPSI Restricting and Body Dissatisfaction scales were not significant predictors of ICB-WGA, whereas the AUDIT and EPSI Cognitive Restraint, Excessive Exercise, Purging, and Binge Eating scales significantly predicted ICB-WGAs. Results indicated that disordered eating and alcohol use both added incremental validity to the prediction of ICB-WGA; however, ICB-WGA was more strongly related to disordered eating, and this was particularly true for women. Our findings suggest that individuals engaging in ICB-WGA may be at-risk for future development of both eating and substance disorders. Notably, our findings highlight the need for future research to focus on trans-diagnostic prevention programs that target mechanisms that underlie both disordered eating and substance misuse.

Gender-moderated links between urgency, binge drinking, and excessive exercise

OBJECTIVE

Exercise correlates with alcohol use, but the nature of this relation and the extent to which it is maladaptive remains unclear. Urgency and motives for engaging in drinking and exercise might indicate when these behaviors are problematic. The current study examined whether urgency moderated the association between exercise motivated by weight loss and drinking.

PARTICIPANTS

College students (N = 589, 45.7% male) completed the study during the spring of 2012.

METHODS

Participants completed self-report assessment measures, including frequency/quantity of alcohol consumption, exercise for weight loss, and urgency, during a single session.

RESULTS

Negative urgency moderated the relation between exercise and alcohol consumption in men but not women; the link between excessive exercise and alcohol use was stronger for men with higher levels of urgency.

CONCLUSIONS

Further clarification of the mechanisms underlying alcohol use and physical activity-particularly maladaptive approaches to exercise-will inform health interventions among college students.

Cross-Sectional Associations between Empirically-Derived Dietary Patterns and Indicators of Disease Risk among University Students

The transition from adolescence to adulthood is a unique period during which lifelong dietary habits are shaped. Dietary patterns (DPs) among young adults attending college have not been adequately described, and associations between DPs and indicators of disease risk are not well understood in this age group. Dietary data were collected from undergraduates participating in the Tufts Longitudinal Health Study (TLHS; 1998-2007) by Food Frequency Questionnaire (FFQ; n = 1323). DPs were derived using principal components analysis with varimax rotation. Scree plots; eigenvalues; factor loadings; and previous studies were used to determine and label the DPs retained. Cross-sectional relationships between DP scores and anthropometric measures (percent body fat (PBF) and (BMI) and lipid biomarkers (total; HDL and LDL cholesterol; and triglycerides) were assessed with multivariable regression models; adjusted for demographics; physical activity; smoking; intention to gain/lose weight; and total energy intake. Effect modification by sex was tested. Three DPs were identified: Prudent; Western; and Alcohol. Greater adherence to the Prudent DP was associated with favorable anthropometric outcomes. The Alcohol DP was associated with a favorable lipid profile. Associations between the Western DP and blood lipids differed by sex; with unfavorable impact observed only among males. Our findings add to the literature linking DPs in young adults with measurable adiposity and cardiometabolic outcomes; suggesting that improving nutrition among college students could reduce chronic disease risk.

Validation of the Italian version of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS)

The aim of the study was to evaluate, in a representative sample of high school students, the psychometric characteristics of the Italian version of the CEBRACS scale (Rahal et al., 2011), a questionnaire investigating compensatory eating behaviors correlated with alcohol consumption. These behaviors are adopted to make up for calories consumed through the drinking of alcohol and/or to enhance the intoxicative effects of alcohol. Study participants were selected from an initial sample of 965 students. Out of the 965 youths originally recruited, 640 (376 males and 264 females) reported drinking alcohol over the previous 3 months, and were considered eligible for the purpose of the study. The following questionnaires were administered: CEBRACS, Alcohol Use Disorders Identification Test (AUDIT) (Saunders, 1993), and the Eating Disorder Inventory-3 (EDI-3) (Garner, 2004). Test/retest reproducibility was evaluated on a subgroup of 189 youths. The factorial structure, internal consistency, test–retest reliability and concurrent validity of CEBRACS were evaluated. Factor analysis of inter-item correlation indicated 5 factors as being better suited to describe data, with an estimated 68.85% variance: "Alcohol Effect, "Laxative Use", "Dietary Restraint and Exercise", "Diuretic Use", "Restriction and Vomiting". A high degree of reproducibility and homogeneity (ICC = 0.806; Cronbach's Alpha = 0.886) of the scale was detected. A significant correlation was revealed between CEBRACS, the three eating disorder risk scales comprised in EDI-3 and scores and clinical risk yielded by AUDIT. The overall reliability and validity of the CEBRACS scale was confirmed in an extensive sample of Italian students, highlighting a satisfactory construct validity, good internal consistency and good degree of reproducibility. In view of the relevance of the problem, associated with serious health risks, a more widespread investigation of the phenomenon should be conducted using evaluation tools of proven validity and reliability on both representative samples of the general population and clinical samples.

Eating Disorders and Associated Health Risks Among University Students

OBJECTIVE

To determine the prevalence of eating disorders among university students and its relationship to behavioral characteristics and substance use.

DESIGN

Cross-sectional study collected socioeconomic characteristics and behavioral risk.

SETTING

University of Upper Normandy, France.

PARTICIPANTS

University student volunteers.

PHENOMENON OF INTEREST

The Sick, Control, One stone, Fat, Food (SCOFF) screening test was used to identify subjects with eating disorders by a confidential questionnaire self-administered either online or on paper.

ANALYSIS

Multivariate logistic regression models with P < .05 considered significant.

RESULTS

A total of 3,457 students were included with a male-to-female ratio of 0.57. The prevalence of positive SCOFF screening was 20.5% among students. A positive relation between the positive SCOFF was observed with female gender (adjusted odds ratio [AOR], 2.98; 95% confidence interval [CI], 2.28-3.89; P < .001), stress (AOR, 1.10; 95% CI, 1.09-1.12; P < .001), depression (AOR, 8.62; 95% CI, 3.37-22.10; P < .001) alcohol abuse problems (AOR, 1.52; 95% CI, 1.20-1.95; P = .006), and risk of cyber-addiction (AOR, 5.09; 95% CI, 2.69-9.62; P < .001).

CONCLUSIONS AND IMPLICATIONS

Eating disorders are highly prevalent among university students in France and associated with other behavior risks, stress, and depression. It might prove necessary in the future to screen students with the SCOFF questionnaire upon entry to the university to inform student about the risk of eating disorders and advise them to consult with their general practitioner.

Trying to Lose Weight and Alcohol Misuse Among High School Girls: Findings From the U.S. National 2011 Youth Risk Behavior Survey

BACKGROUND

Trying to lose weight has been associated with alcohol use among college-aged females. Excessive drinking along with purging as a method for weight control has been documented in this population. However, little is known about the relationship between alcohol use and trying to lose weight among high school girls.

OBJECTIVES

To examine the relationship between trying to lose weight and past 30-day (1) alcohol use and (2) binge drinking (separately).

METHODS

Using data from the National 2011 YRBS, we examined these relationships among 5,106 girls aged 14-18+ who reported ever using alcohol. Survey-weighted iterative logistic regression models were conducted.

RESULTS

44.0% of girls reported current alcohol use with 27.8% reporting binge drinking. While a significant relationship was not found between trying to lose weight and current alcohol use in the final multivariable model, a significant relationship was found between trying to lose weight and binge drinking (AOR: 1.24, 95% CI: 1.02-1.52). Additional variables that were found to be associated with an increased odds of binge drinking included: being in 11th and 12th grades compared to being in 9th grade, screening positively for depression, and current cigarette use. Variables associated with a decreased odds included: talking to an adult/teacher about a problem, and identifying as Black/African American compared to White.

CONCLUSIONS/IMPORTANCE

Understanding the relationship between trying to lose weight and binge drinking among high school students is important, as these behaviors may be a precursor to risk behaviors later in life and need to be more fully examined.

Trading between healthy food, alcohol and physical activity behaviours

BACKGROUND

While recent lifestyle studies have explored the role that food, alcohol or physical activity have on health and wellbeing, few have explored the interplay between these behaviours and the impact this has on a healthy lifestyle. Given the long term health advantages associated with leading healthier lifestyles, this study seeks to: 1) explore the interplay between the food, alcohol and physical activity behaviours of young adults (aged 19-26 years) in the North East of England; 2) explore the trade-offs young adults make between their food, alcohol and physical activity behaviours; and 3) recognise the positive and negative associations between the three behaviours.

METHODS

Qualitative self-reported lifestyle diaries and in-depth interviews were conducted with 50 young adults from the North East of England between February and June 2008. Qualitative thematic analysis was undertaken using Nvivo QSR software, and diary coding using Windiets software.

RESULTS

Young adults who attempt to achieve a 'healthy lifestyle' make trade-offs between the food and alcohol they consume, and the amounts of physical activity they undertake. There are negative reasons and positive consequences associated with these trade-offs. Young adults recognise the consequences of their behaviours and as a result are prepared to undertake healthy behaviours to compensate for unhealthy behaviours. They prefer certain strategies to promote healthier behaviours over others, in particular those that relate to personalised advice and support, more affordable ways to be healthier and easily-accessed advice from a range of media sources.

CONCLUSIONS

Young adults seek to compensate unhealthy behaviours (e.g. binge drinking) with healthy behaviours (e.g. physical activity). Creative solutions may be required to tackle these trade-offs and promote a balance across the food, alcohol and physical activity behaviours of this age group. Solutions that may be effective with this age group include environmental changes (e.g. green spaces and increasing the price of alcohol) designed to encourage and facilitate young people making healthier choices and improving their access to, and lowering the price of, healthy food products. Solutions must recognise these trade-offs and in particular, the strong reluctance of young adults to alter their higher-than-recommended levels of alcohol consumption.

"Drunkorexia": exploring the who and why of a disturbing trend in college students' eating and drinking behaviors

OBJECTIVE

"Drunkorexia," limiting food intake before alcohol consumption, increases college students' risk for negative alcohol-related health consequences. The current study tested whether (1) women engage in drunkorexia more frequently than men; (2) weight control motivations explain sex differences in drunkorexia; and (3) among women, weight control motivations are a particularly strong predictor of drunkorexia for heavier drinkers.

PARTICIPANTS

Undergraduate males and females (N = 63) recruited during fall of 2011.

METHODS

PARTICIPANTS self-reported their alcohol consumption, drunkorexia, and weight control motivations online.

RESULTS

Findings supported hypotheses: weight control motivations explained why women engage in drunkorexia more than men; and the weight control motivation → drunkorexia relation was strongest for heavier- (vs lighter-) drinking women.

CONCLUSION

Women have more weight concerns than men, which makes them more likely to engage in drunkorexia. Heavy-drinking women with strong weight control motivations are at greatest risk for drunkorexia. Interventions should help students more safely reconcile pressures to be thin and drink alcohol.

Do restrained eaters restrict their caloric intake prior to drinking alcohol?

This research used multilevel modeling to investigate the hypothesis that restrained eaters increase dietary restriction when they expect to drink alcohol. Undergraduate women (39 restrained eaters; 40 unrestrained eaters) monitored their food and alcohol intake for ten days. Restrained eaters, on average, consumed fewer calories per day than unrestrained eaters. Although the intent to drink alcohol did not impact the overall caloric intake of restrained eaters prior to drinking, restrained eaters reported significantly fewer eating episodes than unrestrained eaters on days the participants intended to drink. Given that restrained eaters generally consumed fewer calories per day and had fewer eating episodes prior to drinking, one major implication of higher levels of intoxication would be increased risk of negative alcohol-related consequences. Future research should extend this study and evaluate negative alcohol-related consequences that occur with higher levels of intoxication.

Appropriate terminology for the alcohol, eating, and physical activity relationship

"Drunkorexia" merges prior literature identifying positive relationships between (a) alcohol use/abuse and disordered eating/eating disorders, (b) alcohol use/abuse and physical activity, and (c) disordered eating/eating disorders and physical activity. The term, highlighting an individual's proactive and/or reactive weight management behaviors (ie, disordered eating, physical activity) in relation to alcohol consumption, originated in news editorials and has recently gained recognition via use in scholarly publications. The purpose of this commentary is to recommend discontinuing use of the term "drunkorexia" due to (a) inconsistent definitions of drunkorexia across investigations, (b) drunkorexia being a misnomer, and (c) the medical community's lack of recognition/acceptance of drunkorexia. Because the behaviors encompassed by drunkorexia are of concern to researchers and health professionals, future investigations are still warranted. However, until a medically recognized term/phrase is accepted, scholars should utilize more appropriate characterizations such as "weight-conscious drinkers," "weight management behaviors of drinkers," or "Eating Disorders Not Otherwise Specified" (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision).

Gender differences in the associations among body mass index, weight loss, exercise, and drinking among college students

OBJECTIVE

To explore gender differences regarding weight management behaviors of college drinkers.

PARTICIPANTS

Nationally representative sample of college students from the fall 2008 American College Health Association's National College Health Assessment II (N = 26,062 students).

METHODS

Structural equation modeling was used to examine potential gender differences in associations among exercise, weight loss behaviors, and alcohol use.

RESULTS

Critical ratio tests revealed that associations between exercise and weight loss behaviors were more strongly correlated among females as compared with males. For females, there was a small negative association between exercise and drinking behaviors; in contrast, for males, there was a positive relationship between exercise and alcohol use. Weight loss behaviors were positively associated with drinking for both female and male students; however, the association was significantly stronger for females.

CONCLUSIONS

This investigation furthers previous research on drunkorexia and also sheds additional light on the gender-based differences in weight management behaviors of drinkers.