Introduction
This systematic review focused on 25 studies that aimed to determine the connection between weight gain, amount and specifics of alcohol consumption, and other related factors, for instance, education or exercise levels. In general, the examined research varied in the number of studied individuals, factors that the researchers considered, although the methodology of the majority was similar. The studies were conducted in the following countries – United Kingdom, Nigeria, Russia, Korea, Australia, United States, Scotland, Brazil and Finland.
Most studies were longitude, while some cross-sectional, population and randomised studies are also examined in this review. The diversity of evidence and quantitative and qualitative factors examined by researches in question suggests that some connection between alcohol consumption and obesity exists; however, more research is necessary to determine the specifics of this issue.
The Connection between Alcohol Consumption and Weight
Several studies included in this systematic review focused on determining whether a correlation between consuming alcohol and gaining weight or being obese exists. Specifically, Grucza et al. (2010) examine a population of adults in the United States with substance abuse disorders to determine whether this issue can be used to predict future weight disorders. The authors of this article used data connected to self-reported weight and height used to calculate BMI, and family history of alcoholism to establish whether a link between the two factors exists. Several approaches to diagnosing obesity exist; however, most studies examined in this review use the body mass index (BMI) as the indicator.
All studies examined in this research cite the rising concern of obesity cases globally and a need to address this problem with adequate policies, which includes changing the approach to pricing and marketing beverages containing alcohol. The reason why much attention is dedicated to studying the effects of alcohol on a human’s body and more specifically on the risks of obesity is connected to the several biological and behavioural factors.
Alcohol is a contributing factor to increased fat storing in a human’s body. This element is connected to lipid oxidation, which is examined in depth by Ahaneku et al. (2014) who argue that favourable high-density lipoprotein levels were observed in people consuming alcohol on a daily basis and those who did not drink at all, while those drinking on a weekly basis did not have favourable test results in this domain. Next, Albani et al. (2018) suggest that the behaviour alteration caused by the psychological impact of alcohol is another contributor to obesity since prior research suggests that people are more prone to making unhealthy food choices and experience higher levels of hunger. Hence, varied biological and psychological implications are connected to alcohol consumption.
Specifically, the examined evidence aimed to evaluate the specifics of how alcohol affects the processes that occur in the human body. Downer et al. (2017) substantiate these claims arguing that in most cases calories that result from alcohol intake are supplementary to those received from food, resulting in the overall higher intake and thus increased risk of gaining weight. Another aspect is the impairment of satiety signals as a result of drinking alcohol that can lead to individual eating more than usual upon consuming alcoholic beverages.
The metabolic processes that determine the ability of the body to use calories that were ingested are altered by alcohol. Barry et al. (2014, p. 496) state that “ethanol is oxidised as the primary source of fuel over carbohydrates, proteins and lipids.” This suggests that alcohol consumption patterns and their impact on a human body are intricate and in some ways, controversial.
The patterns associated with consuming alcohol play an essential role in determining the impact of this behaviour of one’s health and BMI. Fazzino et al. (2017, p. 169) state that “regular heavy episodic drinking in young adulthood is associated with a higher risk of gaining excess weight and transitioning to overweight/obesity.” However, the authors note that most young adults in the United States, which is the examined population, tent to choose regular episodic drinking, for instance, once a week or once a month, which involves high levels of alcoholic beverage intake.
In general, the participants reported having more than five drinks for men and more than four for women, which exceeds the recommendations of the United States, national agencies. This results in over 600 additional calories consumed during a single drinking episode, which considering the regular nature of such behaviour serves as a predictor for an increase in a person’s BMI (Fazzino et al. 2017). The evidence collected in this study suggests that the above-described behaviour is an indicator of potential weight gain within the following five years.
Hence, the evidence from different studies either substantiate the claim that alcohol and obesity are connected to refute this assumption by highlighting insufficient evidence. One can argue that the problem is the difference of methodologies used by different researchers; however, most studies rely on data collected by national longitude examinations or through direct interviews. The approaches to collecting and analysing information about the weight and quantity of consumed alcohol are similar.
Yoon, Kim and Doo (2016) found that alcohol is not the only predictor of gaining weight since the unhealthy habit of consuming a lot of alcohol-containing beverages can be a result of stress that a person is subjected to throughout his or her life. It is essential to consider this element when evaluating the impact of alcohol on obesity because designing an adequate intervention for this problem will require a comprehensive understanding of the root cause.
The connections between stress, alcohol consumption, and weight increase can also provide a better understanding of why some studies on the topic contradict each other by providing different results where subjects either gain weight or remain lean even when consuming alcohol. People who self-report higher levels of stress are typically consuming more alcohol, highlighting a relationship between this psychological issue and unhealthy habits (Yoon et al. 2016). Therefore, the consumption of alcohol is influenced by different factors that can have an indirect impact on obesity, as well.
While the focus of this systematic review is specifically on the correlation between alcohol and obesity, understanding other related factors can improve the conclusions regarding the impact of alcohol consumption on both one’s health and weight. Zaridze et al. (2014) examined a population of Russian citizens who consume alcohol and the causes of death that could be directly or indirectly affected by this substance. In general, it was concluded that alcohol has a variety of health-related effects on one’s health and is usually associated with other bad habits, such as smoking. Regardless, Zaridze et al. (2014) also provided evidence that supports the claim that no major correlation between alcohol consumption and obesity exists. The authors applied qualitative measures using self-reported information from the participants, which can be viewed as a limitation for interpreting the results.
Despite the contradictory findings, some evidence suggests that a correlation between alcohol intake and obesity exists. Wymond et al. (2016) state that in their observation, people who consumed the most significant quantities of alcohol in a week also had the highest BMI. This information can serve as an implication for further research into the correlation between the quantity of drinking and weight outcomes. Table 1 presents an assessment of alcohol intake, gender and percentage of energy from the drinks that can help explore the issue of additional calories derived from alcoholic drinks.
Biological Implications
Some of the evidence previously discussed in the paragraphs above highlight the biological elements of alcohol consumption and its impact on a human’s body, such as metabolic rate or lipids. It is helpful to compare the findings of this paper to those of other systemic reviews that consider both quantitative and qualitative evidence in regards to alcohol and obesity. Wills, Evans and Hopfer (2017) focus on phenotypes and the possible relationship between this characteristic and likelihood of developing obesity due to drinking alcohol. The explored evidence suggests that genetic characteristics can affect lower BMI results in individuals who consume alcohol. Table 2 shows an assessment of the author’s findings in regards to BMI and number of drinks for each gender.
Suggestions
While both obesity and substance abuse disorders, including alcoholism, are severe issues that require professional help, some of the examined evidence suggest best practices that can help combat the two problems. Hagnas et al. (2017) and Maclnnis et al. (2014) argue that an exercise intervention similar to practices used within the military can be beneficial in the cases of people with obesity and large amounts of alcohol consumption.
This suggestion is based on the examination of young adults engaged in frequent binge drinking and middle-aged adults. Hagnas et al. (2017) report that binge drinking is connected to weak body composition, although the authors do not correctly cite obesity as a prevalent issue among the examined population. The findings indicate that at least 4 hours of physical activity per week, which is consistent with the amount of training received by military professionals in Finland, can mitigate the adverse effects that alcoholic beverages have on one’s body.
It is possible that most alcohol drinkers are unaware of the energy value that their drinks have. Butler, Poti and Popkin (2016), Barry et al. (2014), Shelton and Knott (2014) and Pajari et al. (2010) argue that alcohol drinkers usually fail to adjust their calorie intake based on the amount of alcohol they consume, which is an essential part of the issue. Hence, promoting a need to dedicate more attention to this aspect can serve as an essential intervention approach to mitigate the risks of obesity.
Non-Drinkers
A vital contribution to understanding the connection between BMI, obesity and alcohol is the comparison of BMI of non-drinkers with those who regularly consume alcohol. Barry, Piazza-Gardner and Holton (2014) reviewed a population sample of 27,774 college students from the United States to determine whether a relationship between the two factors examined in this review exists. Contrary to other research, this study reports that individuals who consumed alcohol had a smaller waist, which is an important predictor used to diagnose obesity.
Notably, the results presented by Barry et al. (2014) contradict the findings of Albani et al. (2018), who examined a population of young adults living in the United Kingdom and their drinking habits. Notably, high intake of alcohol was linked to obesity for men, suggesting that gender-related differences affecting alcohol consumption impact on one’s health exist.
The evaluation of individuals who do not drink alcohol or those who drink it only occasionally is vital for this review since some evidence suggests that limited consumption of alcoholic beverages can have beneficial effects for one’s health. The evidence explaining the specifics of metabolic processes occurring upon alcohol consumption should serve as evidence suggesting that drinkers are more prone to having a higher BMI when compared to those who do not drink.
Gender
One aspect of weight management and connection of obesity to alcohol is the differences that men and women experience in regards to this issue. As was mentioned, Albani et al. (2018) found that men who regularly drink alcohol are more prone to being obese when compared to women. This study is also significant because it highlights the connection between the amount of alcohol that a person drinks on a single occasion, for instance, very high or low intake, and associated weight measurements.
Albani et al. (2018) argue that the number of young adults they examined those who tended to drink more on one occasion was more likely to be obese when compared to individuals who drunk less alcohol. The difference between male and female drinkers, in this case, is that females who consumed both high and very high amounts of alcoholic beverages were prone to being obese, while for males this only included those drinking very high amounts.
The collected evidence suggests that no correlation between a type of an alcoholic drink and weight outcomes over long periods of observation exists. Downer et al. (2017) specifically focused their research on the types of alcohol and its impact on BMI. However, the authors’ research suggests that the type of alcoholic beverage, for instance, whiskey, liquor, wine, or different types of beer do not have impact a person’s weight significantly. An essential contribution of this study is the fact that it revealed a connection between obesity risks and consumption of alcoholic beverages above moderation for men.
Multiple evidence suggests that the link between alcohol intake and weight issues is more significant for women than men. Grucza et al. (2010) report that women who have family members suffering from substance abuse disorders have a much higher chance of becoming obese. While the examined population of men also displayed a similar correlation, it was less statistically significant when compared to that of females.
Gender differences can be seen in the patterns of alcohol consumption and choice of drinks, which suggests a need for assessing the obesity implications for men and women separately. In the study by Yoon et al. (2016) based on data assessed from 6,299 Koreans, a difference in weight fluctuations connected to alcohol consumption highlights differences between men and women. However, the data collected by the authors differs from that found in other studies, because of the focus on unhealthy habits related to stress for both genders. Yoon et al. (2016) conclude that men are more likely to consume high volumes of alcohol in response to stress when compared to females.
However, in this study both men and women sample groups had comparable rates of obesity, suggesting that the quantity of a consumed substance that has a direct impact on the daily calorie intake is the key aspect determining the prevalence of overweight subjects in some studies.
The studies explored in this discussion section are varied and provide a comprehensive overview of the correlation between obesity and consuming alcohol. It is evident that drinking small quantities does not threaten one’s health, although some evidence suggests that occasional drinkers can be subjected to a more significant number of health-related adverse effects. In general, the scholarly research explored in this systematic review suggests that alcohol has an impact on a person’s metabolic rate and fat storage processes. However, solely this factor should not be considered when evaluating potential risks and interventions, because it is as suggested by the findings of this review, bad habits connected to alcohol abuse are usually a result of other psychological issues, for example, high levels of stress.
Unlike previous researchers, some studies present evidence that females are more prone to suffering from the negative effects of alcohol. Da Rocha et al. (2016) conducted an analysis of data from a national longitude investigation in Brazil to determine the correlation between gender, a number of drinks per day or lack of alcohol consumption and obesity. The findings from this sample of 514 people of conflicting evidence because it suggests that the majority of non-drinkers, more specifically, 63.7% had excess weight.
The initial conclusion is that alcohol does not affect the likelihood of becoming obese and people who do not drink alcohol can be overweight as well. However, Da Rocha et al. (2016, p. 1983) also conclude that some specific characteristics that differ between men and women in regards to alcohol and weight were present in the observed population since the authors state that “low-to-moderate daily alcohol consumption was associated with increased adiposity in men, independently of age, nonalcohol calories intake, physical activity and education.” However, the authors do not provide a comparison of the intake for men and women that would allow assessing the calorie intake for both groups.
It can be concluded that in some cases, a direct link between the quantity, frequency of consumption and gender can be seen. Zaridze et al. (2014) and Smarandescu, Walker and Wansink (2014) also substantiate the claim that alcohol consumption affects the weight of men and women differently by providing evidence that women who consume small quantities of alcohol have a higher BMI. However, both men and women display no significant increase in BMI if the amount of consumed alcohol is more significant than 0,5 litres.
Hence, this study also supports the claim that occasional drinkers can suffer from adverse consequences of alcohol consumption connected to weight gain, while those regularly drinking large quantities do not usually suffer from obesity (Zaridze et al. 2014). This assumption about alcohol is consistent with the evidence from another study about college students that were previously discussed and suggests a pattern connected to the number of alcoholic beverages a person drinks.
Adiposity requires additional attention since the process is interconnected and influenced by alcohol consumption. Chakraborty (2014) managed to locate a lot of person-specific information, for instance gender, race, age, sex, weight, education to determine between the two factors, alcohol and obesity using the data from 1999-2000 surveys. In general, after adjusting the analysis for various factors, the findings suggest that people who never drink alcohol are more likely to be obese when compared to drinkers. However, a correlation was also found between drinking for long periods of time, binge drinking or consuming large quantities of alcohol, which is also associated with more chances of becoming obese.
Alcohol and Diet
One of the significant implications connected to the idea that alcohol can be a significant contributor to the increasing number of obese individuals is the contribution to the daily energy intake that it provides. An evaluation by Wymond, Dickinson and Riley (2016) can provide insight into understanding why women are more likely to gain excess weight associated with alcohol consumption than men since the authors found that for both groups, the contribution from alcohol to the daily energy intake is similar. However, the energy needs of women are smaller than those of men and consuming a similar quantity of additional calories can result in obesity for women.
Mixed Results
The topic of alcohol intake and its impact on obesity remains to be understudied since many factors that play a role in gaining weight connected to alcohol are not researched. Some studies produce in this field produce mixed results, suggesting a need to change approaches or methodologies applied by scientists. One example illustrating the issue is Arabshahi et al. (2014) who conducted a longitude study over 15 years to examine the socioeconomic and lifestyle factors, which can be linked to obesity. The findings fail to highlight a clear connection between consuming alcohol and experiencing an increase in waist size.
Downer et al. (2017) and Ahaneku et al. (2014) cite prior research suggesting that moderate intake of alcohol can have beneficial effects for a person’s health, which is another essential factor that should be examined since it provides recommendations for managing alcohol intake to avoid risks of obesity and cardiovascular diseases or other complications. This review provides evidence that alcohol consumption may have an adverse impact on a person’s BMI and hence be a contributor to an increasing problem of obesity.
Methods and Findings
In most cases, the studies Barry et al. (2014) argue that a standard feature and issue characterising research into alcohol and BMI is the fact that no standardised approach to measuring the actual consumption exists. Hence, the results vary, and some researchers report a significant relationship between alcohol and obesity while others note that no such connection exists due to different methodologies that a particular group of research uses. In most cases, the distinguishment is made between drinkers and non-drinkers, while the frequency of drinking, for instance, once a month or twice a month is also considered.
Gender of participants is usually an essential factor included in the examination of finding since some evidence suggests that it is connected to BMI and alcohol consumption patterns (Barry et al., 2014). Most data were collected from national surveys or national longitude studies, although some researchers observed participants directly.
In most cases, examiners used measurable indicators such as BMI, body fat percentage, or waist size to distinguish between obese and normal-weight individuals. However, Hagnas et al. (2017) used a more biased approach of evaluating body composition as part of their research, providing a different outlook on the aspect of weight management. Alcohol consumption, frequency and type of beverages in most cases were self-reported, which arguably can lead to particular bias within the results.
This indicates a need to focus on determining the reasons that affect the differences between drinkers and non-drinkers and their BMI. The use of BMI index in most of the studies examined in this reviewed can be questioned since the metric does not account for the differences in body types and other associated aspects of human anatomy. Additionally, some researchers chose to measure the waist size of the participant, which can be a better indicator of obesity risks and associated health threats. The difference in methods makes comparing outcomes and findings of varied research severe because the metrics represent different approaches.
Some studies focus on adiposity as the primary indicator of health-related issues connected to alcohol consumption. Hangas et al. (2017) focused on body composition and percentage of fat as the primary indicator.
Also, cross-sectional studies examined in this reviewed are unable to detect and establish temporality, which would help gain a better understanding of the time as a factor in gaining weight, which is explicitly stated in the research by Da Rocha et al. (2016) and this aspect should be considered when evaluating the findings. This is important because the process of weight gain usually occurs over long periods of time. However, because this cross-sectional review contains longitude studies, the evidence can be aggregated to make conclusions about the long and short term effects of alcohol on one’s weight.
The differences in the results presented by varied researchers suggest a need to account for a variety of factors that can contribute to obesity in order to accurately track the connection. Researches, such as an examination by Yoon et al. (2016) only review the direct connection between alcohol and weight gain and do not account for other factors. The limitation of the research by Yoon et al. (2016) is that it does not consider other contributing factors.
However, the conflicting findings on the topic of obesity suggest that other examinations and studies should aim to find a correlation between other aspects, such as mental state, its impact on alcohol consumption and resulting weight gain. For instance, Da Rocha et al. (2016) attempted to assess other factors, such as levels of physical activity or education levels, since exercise affects the energy balance of one’s body and can help burn excess calories consumed from alcohol and advanced knowledge about the contemporary obesity problem and its implications can help people develop personalised interventions.
Self-reported quantitative and qualitative measures can sometimes be inaccurate, which should be considered when examining the findings. The possibility of bias is another issue that is pointed out by Da Roca et al. (2016) and other researchers since some studies were conducted in environments such as a workplace, which can lead to untruthful responses from participants in regards to the doses of consumed alcohol or weight.
This, however, does not relate to the weight metrics used by researchers, since BMI, weight, waist size or fat indexes were calculated based on measurements conducted by professionals. A study by Zaridze et al. (2014) interview families of the diseased to determine the quantity of alcohol consumed per day, which is an unreliable source of information. Hence, one can argue that the reported intake of alcohol should be regarded with caution in all presented studies, although a connection between consumption and obesity can still be seen with this data.
Some studies cite the inability to accurately track food after alcohol consumption as a significant limitation of their and other similar studies. It is an essential element that should be considered because obesity does not result from alcohol consumption directly, but rather from an increased appetite and inability to track satiation correctly. Many of the examined studies were longitude, meaning that alcohol consumption patterns and associated weight changes were monitored by researchers over long periods, which suggests that the explored evidence is reliable.
Other Literature
In order to fully understand the implications of the studies and evidence that have different results when evaluating the association of alcohol consumption with obesity, it is helpful to examine other literature on the topic, including different systematics reviews. Oosterveen et al. (2017) focused on examining the existing intervention practices and behaviours or other elements that were the focus of these approaches. Alcohol consumption was cited to be one of the elements targeted by researchers; however, it was always accompanied by other elements, such as physical activity and diet. This outcome is similar to the findings of this review, which suggest that obesity is connected to alcohol consumption, but other factors should be reviewed as well.
Implications of the Research
In general, while some studies produce controversial evidence, most researches agree that heavy consumption of alcoholic beverages significantly increases the risks of becoming obese. The focus on heavy consumption is important because evidence suggests that individuals who occasionally drink alcohol are not subjected to weight gain over time. Another important finding is that the difference is the potential danger of alcohol consumption within female and male populations, with the former being more prone to gaining weight due to alcohol consumption. The evidence suggests that young adults should be informed of the dangers that heavy episodic drinking has due to the behavioural and biological impact of the substance on one’s body.
The evaluation of the findings, methods and limitations of the obesity studies presented in this review suggests that the problem should be further explored using different approaches and evaluating a variety of factors. The qualitative and quantitative nature of the obesity studies explored in this review provides a better understanding of the perceived and actual outcomes of alcohol consumption.
Most studies that involved direct observation of participants and not an assessment of secondary data relied on self-reported information from the population sample to evaluate the perceived effects of alcohol consumption on one’s health and quality of life. The analysis of the findings suggests that more research into the topic is necessary because of conflicting evidence that either support or refute the argument regarding alcohol being a significant contributor to obesity. It is also necessary to conduct studies that would apply methodology, which illuminates bias of the self-reported assessments.
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