Road to 'Drunkorexia'

In a culture that's still obsessed with dieting, the U.S. weight loss industry is worth around $60 billion and growing. In recent years, there's been an important addition to that market: alcoholic beverage companies. Marketing increasingly plays to consumers' insecurities by perpetuating the myth that we can -- and should -- drink without gaining weight.

At the same time, researchers have noted a disturbing trend, especially among college students, that combines the worst of drinking and dieting. They call it "drunkorexia," which is colloquial for skipping meals or exercising heavily to "save" or burn calories, making room for drinking at night.

While not yet a formally recognized eating disorder, habitually drinking on an empty stomach can of course have serious consequences. Alcohol marketers might not mind you equating food calories with booze calories, but health professionals agree that they're just not interchangeable.

Adam Barry, a professor of health education and behavior at the University of Florida, has compiled the most comprehensive research to-date on drunkorexia, published last spring in the Journal of American College Health.

Barry examined 22,000 college students across 40 universities and found that, even after controlling for race, school year, Greek affiliation and whether a student lived on campus (the authors did not control for whether a respondent played on a sports team), vigorous exercise, and disordered eating uniquely predicted binge drinking. In fact, those who exercised or dieted to lose weight were over 20 percent more likely to have five or more drinks in a single sitting. Students who had vomited or used laxatives in the previous month to shed pounds were 76 percent more likely to binge drink.

Daniella Sieukaran, a clinical psychology graduate student at Simon Fraser University in British Columbia, was already convinced that students were offsetting alcohol calories by extreme dieting. Over the past four years, there have been several studies documenting how common drunkorexia is on college campuses, she said, citing research that as high as 26 percent of young adults use the unhealthy practice to manage their weight. Sieukaran was interested in the longer-term effects of the behavior, and found that, among 227 undergrads at York University in Toronto, students who dieted and drank heavily were more likely to engage in unprotected sex and to require medical treatment for an alcohol overdose.

Dr. Mark Peluso, director of the Middlebury College health center, points out that drinking on an empty stomach leads to more rapid absorption of alcohol, and higher levels of impairment and intoxication. So every time people purposely do it, they incur increased risks of things like sexual assault and DUIs, and, in the long run, gastritis, ulcer, and malnutrition.

"Alcohol is a desert of nutrients compared to food," explained Peluso.

For the last five years, though, the alcohol industry has increasingly targeted young people with weight-conscious marketing, tapping straight into teen and twenty-something's body anxiety -- while courting new consumers. And it's worked, according to David Jernigan, director of the Center on Alcohol Marketing and Youth at Johns Hopkins Bloomberg School of Public Health. Especially, unfortunately, for young women.

As Jernigan sees it, there are two distinct (though sometimes, inter-related) categories within weight-conscious alcohol advertising. First, the "fitness friendly" campaigns -- like an Amstel Light ad with an athletically sexy, sweaty, young blond female and the slogan, "Tell Them You've Hired A Personal Trainer From Holland." Or Michelob Ultra presenting itself as a general "fitness beer," with a toned man and woman jogging and the tagline, "95 Cals, 2.6g Carbs, Smart Choice" in one ad and another, with a bunch of runners and cyclists in silhouette, around a tall, thinner beer can. The message there: "Sleek, slim, sophisticated. The Whole Package." (Even the can is skinny.)

The other category: diet alcohol ads, aimed primarily at young females. These promise all the upsides of drinking without any of the pesky weight gain.

It's a funny thing, Jernigan remarked. After decades of marketing alcohol by objectifying and mistreating women, the adult beverage world has suddenly discovered female consumers. It's like Virginia Slims all over again. "There's no question that the alcohol industry is presenting their goods to women as though they're diet products," he said. "Because that's what sells."

Take Anheuser-Busch, which advertises its Select 55 beer directly on Weight Watchers' website. Pushing itself as "The Lightest Beer In the World," it assures dieters that they can "be good ... and still have a good time." Bacardi promotes itself with "diet cola" as the zero-carb drinking alternative, while Beam Inc.'s SkinnyGirl Cocktails advertise ready-to-serve, "low-cal flavors and options." The brand's creator (and the inspiration on the cartoon on the bottle), is the incredibly svelte reality star Bethenny Frankel.

But Jernigan believes that marketing alcohol as a "diet drink" skirts very close to making a spurious health claim, which would be illegal.

For historic reasons, the U.S. Department of Treasury's Alcohol and Tobacco Tax and Trade Bureau, along with the Federal Trade Commission, control alcohol advertising and specifically restrict the use of health-related claims. Under the regulations though, only "misleading" or "deceptive" health statements are prohibited -- and it turns out that's a pretty low bar.

None of the ads above seem to qualify as "false." If a beer only has 55 calories, it may well fit into a Weight Watchers plan. And while most trainers don't tell you to grab a beer after your workout, there's nothing "untrue" about claiming that some biker, somewhere, may want one after a triathlon.

"You pretty much have a government asleep at the wheel," said Michele Simon, a public health lawyer, president of the consulting firm Eat Drink Politics, and author of the report, "Questionable Health Claims By Alcohol Companies." According to Simon, alcohol companies use free speech and the First Amendment to keep regulators at bay -- and continue a "charade of voluntary self-regulation," largely designed to convince policymakers they don't need to intervene, and that the alcohol industry can monitor itself.

For example, the Distilled Spirits Council, a national trade association representing America's major distillers, has a 14-page code of responsible practices for alcohol beverage advertising. The code bans marketing on college campuses other than at a licensed retail establishment, like say, a faculty club, where brands can advertise behind the bar.

According to Frank Coleman, the Distilled Sprits Council's senior vice president for public affairs, ads that mention calories and carbs don't even make a health claim to begin with. Offering a lighter version of an adult beverage product that already exists "is just a labeling issue."

Public health researchers and college health professionals aren't swayed by the labeling argument, though. They're increasingly concerned that diet alcohol ads encourage teens and college students to engage in the troubling behavior that more and more experts are actually calling drunkorexia -- in academic journals. 

Not only does the alcohol industry stand by weight-conscious marketing, but non-alcoholic beverage companies are also moving into the diet alcohol game.

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Kim Jage, sales and marketing director for the first Healthy Beverage Expo in Las Vegas this coming June, didn't anticipate vendors offering alcohol as a healthy beverage when organizers announced the show. But she said consumers should expect more "healthy" alcohol products in 2013 and 2014, with fewer calories and more "organic options," like a new product from Gizmo Beverages, which plans to launch a "100 percent percent natural, preservative-free, low-calorie pre-mixed cocktail" at the show. Gizmo isn't even part of the alcohol industry presently -- it's a tea brand. Nonetheless, Jage predicts the time has come for low-calorie alcohol sales to skyrocket. As it does, we would do well to consider the implications and consequences.