573436 research-article2015
HPQ0010.1177/1359105315573436Journal of Health PsychologyRoosen and Mills
Article
Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students
Journal of Health Psychology 2015, Vol. 20(6) 875–886 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105315573436 hpq.sagepub.com
Kaley M Roosen and Jennifer S Mills
Abstract This study explored the prevalence of and motivations behind ‘drunkorexia’ – restricting food intake prior to drinking alcohol. For both male and female university students (N = 3409), intentionally changing eating behaviour prior to drinking alcohol was common practice (46%). Analyses performed on a targeted sample of women (n = 226) revealed that food restriction prior to alcohol use was associated with greater symptomology than eating more food. Those who restrict eating prior to drinking to avoid weight gain scored higher on measures of disordered eating, whereas those who restrict to get intoxicated faster scored higher on measures of alcohol abuse.
Keywords drinking behaviour, drunkorexia, eating behaviour, eating disorders, females, health behaviour, risk factors, students
The high comorbidity between alcohol abuse and eating disorders (EDs) has been well documented (National Center on Addiction and Substance Abuse at Columbia University (NCASU), 2003). University years are a highrisk period for both ED symptoms and problematic drinking (Substance Abuse and Mental Health Services Administration (SAMHSA), 2010; Tylka and Subich, 2002). While the prevalence of clinical EDs is relatively low (American Psychiatric Association (APA), 2000), prevalence of subclinical ED symptoms (i.e. chronic dieting, intermittent binging/purging) is much higher among young women, with one study estimating the rate at 60 per cent (Tylka and Subich, 2002). Female dieters who are engaged in alcohol abuse are at increased risk for negative alcohol-related consequences including physical
injury and blackouts, compared to those who engage in alcohol use with no history of dieting (Krahn et al., 2005). Given the high prevalence of binge drinking and disordered eating in Canadian college-aged women (Piran and Robinson, 2011), recent attention has been paid to understanding how female dieters negotiate shape/weight concerns while engaging in alcohol use. ‘Drunkorexia’ is a colloquial term that has been used by the media in the last 5 years (e.g. Kershaw, 2008). York University, Canada Corresponding author: Kaley M Roosen, Department of Psychology, York University, 297 Behavioural Sciences Building, 4700 Keele Street, Toronto, ON, Canada M3J 1P3. Email: [email protected]
876 Despite debate on a definition and the appropriateness of the term (Barry et al., 2013), it is generally used to describe young women who restrict their food intake prior to drinking alcohol in order to offset the calories in alcohol and also, in some cases, so that they may become intoxicated faster (Barry and Piazza-Gardner, 2012). Despite limited empirical research, this phenomenon has become a popular topic of discussion among media outlets and Internet groups (Chambers, 2008). Although not a recognized symptom of clinical EDs, caloric restriction prior to alcohol use poses significant health risks, especially for young women (Barry et al., 2013). The concentration of alcohol within the body and the sudden intoxicating effects are amplified by food deprivation (Watkins and Adler, 1993). Repeated episodes of alcohol abuse in combination with food restriction can result in sudden blackouts, alcohol poisoning, increased chances of engaging in risky behaviours and injuries and, over time, cirrhosis of the liver and cognitive decline (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2004). Women are at greater risk than men for the negative effects of caloric restriction prior to alcohol use because they generally have less water in their body (Baraona, 1998) and less gastric alcohol dehydrogenase activity as compared to men (Frezza et al., 1990), resulting in higher blood ethanol concentrations after consuming the same amount of alcohol. Little research exists on planned caloric restriction prior to alcohol use. Peralta (2002) studied the phenomenon qualitatively through semi-structured interviews of 78 students and found that 18 per cent of participants endorsed restricting calories primarily to avoid weight gain and, in some cases, to enhance the intoxicating effects of alcohol. Other studies found that approximately 14 per cent of their student samples engage in caloric restriction prior to alcohol use (Burke et al., 2010; Osborne et al., 2011). Overall, these studies have shown that approximately 64–69 per cent of students who
Journal of Health Psychology 20(6) engage in caloric restriction prior to drinking do so in order to avoid weight gain and 25 per cent do so in order to get intoxicated faster (Giles et al., 2009; Osborne et al., 2011). The main objectives of this study were to investigate the prevalence, mental health correlates and motivations behind intentional eating changes prior to alcohol use. Two studies with independent samples were used to explore these objectives.
Study 1 Study 1 investigated the prevalence of dietary changes prior to planned alcohol consumption in a large sample of Canadian university students. Unlike previous studies, we examined all self-reported methods of changing eating behaviour prior to drinking in order to provide a clearer picture of students’ eating behaviour prior to drinking. Study 1 also identified the motivations for changing one’s eating behaviour prior to drinking alcohol. We hypothesized that food restriction prior to drinking would be more common in women (Piazza-Gardner and Barry, 2013), whereas eating more food to avoid sickness or a hangover would be more common in men.
Method Participants. Participants were undergraduate students from a large, multicultural university located in Toronto, Canada, where the legal drinking age is 19. A total of 3859 students registered in the Fall 2013 semester of Introductory Psychology took part in the study. Of those, 450 participants were excluded because of excessive missing data (>50%) or they were over the age cutoff. The final sample consisted of 3409 students (70% female) aged 16–26 (M = 19.60; standard deviation (SD) = 2.08) years. The ethnic distribution of the sample was 37.1 per cent White, 14.8 per cent East Asian, 21.8 per cent South Asian, 8.4 per cent Black, 2.5 per cent Hispanic, 0.4 per cent Aboriginal and 15 per cent other ethnic identification.
877
Roosen and Mills Procedure. This study received ethics approval from the university. Participants were asked to complete an online survey for which they received partial course credit. Measures. In the absence of any standardized measures of our behaviours of interest, we developed Likert scale items assessing eating habits prior to planned alcohol use based on previous studies (e.g. Burke et al., 2010). First, participants were asked how often they change their eating prior to an occasion where they would be consuming alcohol (‘never’, ‘rarely’, ‘sometimes’, ‘usually’ or ‘always’). A total of 1193 participants were exempt from further questions because they stated that they ‘never’ engage in such behaviour. Second, if applicable, participants were asked how they change their eating prior to drinking alcohol (‘I eat more food’, ‘I eat less food’, ‘I skip a meal’, ‘I skip more than one meal’ or ‘I eat no food’) in order to categorize participants by eating behaviour. Participants who endorsed eating less food, no food or skipping meals were all considered in the ‘eating less’ category. Third, participants were asked to select the primary reason why they change their eating prior to drinking alcohol. Possible reasons included: ‘to avoid becoming sick’, ‘to prevent a hangover’, ‘to avoid gaining weight’, ‘to save calories’, ‘to save money’ and ‘to become intoxicated faster’. Finally, participants were asked to what extent they consider the caloric content in their alcohol (‘not at all’, ‘slightly’, ‘somewhat’ or ‘very much’). Data analysis. Frequency analyses were used to examine the participants’ self-reported eating behaviours and motivations prior to alcohol use. Chi-Square tests with Cramer’s V as the indicator of effect size (Cramer, 1999) were conducted to compare groups across (1) gender, (2) method (i.e. eating more or less), (3) motivation (i.e. primary reason for changing eating prior to drinking) and (4) level of concern regarding calories in alcohol. Nonparametric Chi-Square tests were used for post-hoc analyses of each group in significant Chi-Square tests.
Results Eating changes prior to alcohol use in first-year university students. A total of 46 per cent of the sample selected at least ‘sometimes’ intentionally changing their food intake before an occasion where they knew that they would be drinking alcohol (5% always, 14% usually, 27% sometimes, 19% rarely and 35% never). Of those participants who reported that they changed their eating prior to drinking (n = 1599), 63 per cent reported eating more and 37 per cent reported eating less food. Of those who reportedly eat less food (n = 591), a small number of participants endorsed skipping meals (6%) or eating no food all day (1%) prior to an occasion where they will be drinking alcohol (Figure 1(a)). The most common reasons given for changing one’s eating prior to drinking were to avoid becoming sick (49%) and to prevent a hangover (31%). A total of 10 per cent of participants reported that they changed their eating prior to alcohol consumption in order to avoid weight gain/save calories, 8 per cent endorsed doing so to get intoxicated faster, and 2 per cent reported that they wanted to save money (Figure 1(b)). Pearson Chi-Square analyses results revealed that participants who endorsed eating more food prior to drinking alcohol reported different primary motivations for changing their eating than did those who endorsed eating less food (Figure 1(c)), yielding a large effect size (χ2(4, 1519) = 506.08, p
HPQ0010.1177/1359105315573436Journal of Health PsychologyRoosen and Mills
Article
Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students
Journal of Health Psychology 2015, Vol. 20(6) 875–886 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105315573436 hpq.sagepub.com
Kaley M Roosen and Jennifer S Mills
Abstract This study explored the prevalence of and motivations behind ‘drunkorexia’ – restricting food intake prior to drinking alcohol. For both male and female university students (N = 3409), intentionally changing eating behaviour prior to drinking alcohol was common practice (46%). Analyses performed on a targeted sample of women (n = 226) revealed that food restriction prior to alcohol use was associated with greater symptomology than eating more food. Those who restrict eating prior to drinking to avoid weight gain scored higher on measures of disordered eating, whereas those who restrict to get intoxicated faster scored higher on measures of alcohol abuse.
Keywords drinking behaviour, drunkorexia, eating behaviour, eating disorders, females, health behaviour, risk factors, students
The high comorbidity between alcohol abuse and eating disorders (EDs) has been well documented (National Center on Addiction and Substance Abuse at Columbia University (NCASU), 2003). University years are a highrisk period for both ED symptoms and problematic drinking (Substance Abuse and Mental Health Services Administration (SAMHSA), 2010; Tylka and Subich, 2002). While the prevalence of clinical EDs is relatively low (American Psychiatric Association (APA), 2000), prevalence of subclinical ED symptoms (i.e. chronic dieting, intermittent binging/purging) is much higher among young women, with one study estimating the rate at 60 per cent (Tylka and Subich, 2002). Female dieters who are engaged in alcohol abuse are at increased risk for negative alcohol-related consequences including physical
injury and blackouts, compared to those who engage in alcohol use with no history of dieting (Krahn et al., 2005). Given the high prevalence of binge drinking and disordered eating in Canadian college-aged women (Piran and Robinson, 2011), recent attention has been paid to understanding how female dieters negotiate shape/weight concerns while engaging in alcohol use. ‘Drunkorexia’ is a colloquial term that has been used by the media in the last 5 years (e.g. Kershaw, 2008). York University, Canada Corresponding author: Kaley M Roosen, Department of Psychology, York University, 297 Behavioural Sciences Building, 4700 Keele Street, Toronto, ON, Canada M3J 1P3. Email: [email protected]
876 Despite debate on a definition and the appropriateness of the term (Barry et al., 2013), it is generally used to describe young women who restrict their food intake prior to drinking alcohol in order to offset the calories in alcohol and also, in some cases, so that they may become intoxicated faster (Barry and Piazza-Gardner, 2012). Despite limited empirical research, this phenomenon has become a popular topic of discussion among media outlets and Internet groups (Chambers, 2008). Although not a recognized symptom of clinical EDs, caloric restriction prior to alcohol use poses significant health risks, especially for young women (Barry et al., 2013). The concentration of alcohol within the body and the sudden intoxicating effects are amplified by food deprivation (Watkins and Adler, 1993). Repeated episodes of alcohol abuse in combination with food restriction can result in sudden blackouts, alcohol poisoning, increased chances of engaging in risky behaviours and injuries and, over time, cirrhosis of the liver and cognitive decline (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2004). Women are at greater risk than men for the negative effects of caloric restriction prior to alcohol use because they generally have less water in their body (Baraona, 1998) and less gastric alcohol dehydrogenase activity as compared to men (Frezza et al., 1990), resulting in higher blood ethanol concentrations after consuming the same amount of alcohol. Little research exists on planned caloric restriction prior to alcohol use. Peralta (2002) studied the phenomenon qualitatively through semi-structured interviews of 78 students and found that 18 per cent of participants endorsed restricting calories primarily to avoid weight gain and, in some cases, to enhance the intoxicating effects of alcohol. Other studies found that approximately 14 per cent of their student samples engage in caloric restriction prior to alcohol use (Burke et al., 2010; Osborne et al., 2011). Overall, these studies have shown that approximately 64–69 per cent of students who
Journal of Health Psychology 20(6) engage in caloric restriction prior to drinking do so in order to avoid weight gain and 25 per cent do so in order to get intoxicated faster (Giles et al., 2009; Osborne et al., 2011). The main objectives of this study were to investigate the prevalence, mental health correlates and motivations behind intentional eating changes prior to alcohol use. Two studies with independent samples were used to explore these objectives.
Study 1 Study 1 investigated the prevalence of dietary changes prior to planned alcohol consumption in a large sample of Canadian university students. Unlike previous studies, we examined all self-reported methods of changing eating behaviour prior to drinking in order to provide a clearer picture of students’ eating behaviour prior to drinking. Study 1 also identified the motivations for changing one’s eating behaviour prior to drinking alcohol. We hypothesized that food restriction prior to drinking would be more common in women (Piazza-Gardner and Barry, 2013), whereas eating more food to avoid sickness or a hangover would be more common in men.
Method Participants. Participants were undergraduate students from a large, multicultural university located in Toronto, Canada, where the legal drinking age is 19. A total of 3859 students registered in the Fall 2013 semester of Introductory Psychology took part in the study. Of those, 450 participants were excluded because of excessive missing data (>50%) or they were over the age cutoff. The final sample consisted of 3409 students (70% female) aged 16–26 (M = 19.60; standard deviation (SD) = 2.08) years. The ethnic distribution of the sample was 37.1 per cent White, 14.8 per cent East Asian, 21.8 per cent South Asian, 8.4 per cent Black, 2.5 per cent Hispanic, 0.4 per cent Aboriginal and 15 per cent other ethnic identification.
877
Roosen and Mills Procedure. This study received ethics approval from the university. Participants were asked to complete an online survey for which they received partial course credit. Measures. In the absence of any standardized measures of our behaviours of interest, we developed Likert scale items assessing eating habits prior to planned alcohol use based on previous studies (e.g. Burke et al., 2010). First, participants were asked how often they change their eating prior to an occasion where they would be consuming alcohol (‘never’, ‘rarely’, ‘sometimes’, ‘usually’ or ‘always’). A total of 1193 participants were exempt from further questions because they stated that they ‘never’ engage in such behaviour. Second, if applicable, participants were asked how they change their eating prior to drinking alcohol (‘I eat more food’, ‘I eat less food’, ‘I skip a meal’, ‘I skip more than one meal’ or ‘I eat no food’) in order to categorize participants by eating behaviour. Participants who endorsed eating less food, no food or skipping meals were all considered in the ‘eating less’ category. Third, participants were asked to select the primary reason why they change their eating prior to drinking alcohol. Possible reasons included: ‘to avoid becoming sick’, ‘to prevent a hangover’, ‘to avoid gaining weight’, ‘to save calories’, ‘to save money’ and ‘to become intoxicated faster’. Finally, participants were asked to what extent they consider the caloric content in their alcohol (‘not at all’, ‘slightly’, ‘somewhat’ or ‘very much’). Data analysis. Frequency analyses were used to examine the participants’ self-reported eating behaviours and motivations prior to alcohol use. Chi-Square tests with Cramer’s V as the indicator of effect size (Cramer, 1999) were conducted to compare groups across (1) gender, (2) method (i.e. eating more or less), (3) motivation (i.e. primary reason for changing eating prior to drinking) and (4) level of concern regarding calories in alcohol. Nonparametric Chi-Square tests were used for post-hoc analyses of each group in significant Chi-Square tests.
Results Eating changes prior to alcohol use in first-year university students. A total of 46 per cent of the sample selected at least ‘sometimes’ intentionally changing their food intake before an occasion where they knew that they would be drinking alcohol (5% always, 14% usually, 27% sometimes, 19% rarely and 35% never). Of those participants who reported that they changed their eating prior to drinking (n = 1599), 63 per cent reported eating more and 37 per cent reported eating less food. Of those who reportedly eat less food (n = 591), a small number of participants endorsed skipping meals (6%) or eating no food all day (1%) prior to an occasion where they will be drinking alcohol (Figure 1(a)). The most common reasons given for changing one’s eating prior to drinking were to avoid becoming sick (49%) and to prevent a hangover (31%). A total of 10 per cent of participants reported that they changed their eating prior to alcohol consumption in order to avoid weight gain/save calories, 8 per cent endorsed doing so to get intoxicated faster, and 2 per cent reported that they wanted to save money (Figure 1(b)). Pearson Chi-Square analyses results revealed that participants who endorsed eating more food prior to drinking alcohol reported different primary motivations for changing their eating than did those who endorsed eating less food (Figure 1(c)), yielding a large effect size (χ2(4, 1519) = 506.08, p
