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How can we help drinkers make healthier choices?

by Guest Author on 17 Jan 2019

Pouring beerMany of us enjoy raising a glass when we celebrate, socialise or relax after work. But do you know, or even think, about what’s inside? According to Senior Research Associate Dr Anna Blackwell, probably not. Now that alcohol misuse is the biggest risk factor for ill health, disability and early death for 15 to 49-year-olds in England, Anna tells us why this needs to change.

There are carefully crafted cues all around you that influence your behaviour. Many of these come from industry, like the two-for-one deals or pretty bottles that make you more likely to choose one drink over another. Or the nice sofas and cosy atmosphere that might encourage you to stay longer in a bar then you’d planned.

Our group at the Tobacco and Alcohol Research Group (TARG), part of Bristol’s School of Psychological Science and the MRC Integrative Epidemiology Unit (MRC IEU), think we might be able to use similar methods to encourage people to make healthier choices. We call these ‘choice architecture’ or ‘nudge’ interventions. We spent 18 months developing an evidence base for alcohol labels, glasses and beer mats that could impact drinking.

Uncovering the knowledge gap

We surveyed 1,500 drinkers and asked them about their drinking habits, knowledge about harms related to alcohol use, and whether they could quantify the number of units (the alcohol content) in different drinks.

We discovered a vast knowledge gap between what people perceive to be the health risks associated with alcohol, and the reality. Respondents were aware of the risks of drink driving, drinking in pregnancy, and the link between heavy drinking and liver disease. But they were much less aware of the risk of cancers and heart disease.

Mystifying measures

We also found that people weren’t good at estimating how much they were drinking in units. This makes sense – it can be hard to judge. Wine glasses don’t come with units on. And even if we know we drank three pints of cider one evening, what does that really mean?

As well as finding it difficult to estimate how much they were drinking, most people didn’t know how this compared to the recommended guidelines. When we asked people to tell us the weekly drinking limit in units for men and women, only 11% got it right for both. Few people believed that drinking less would be beneficial for their health, and heavier drinkers were less confident they could change.

Beer mats displaying units per number of drinks for 13% wine by the 175ml glass

Innovative information delivery

As well as finding out what information should be on alcohol labels, we considered other ways messages could be delivered to drinkers in their environment and asked groups of drinkers for their feedback. We designed beer mats for pubs, which put alcohol content in the context of guideline amounts, and developed ideas for an innovative smart-glass that tells you how many units or calories are inside when you pour a drink (see video).

Calorie counting

Alcohol is currently exempt from the labelling standards expected for food and soft drinks, which must have information about their ingredients and nutritional value, covering any drinks that have more than 1.2% alcohol by volume.

Beer mat displaying 250 calories for one 5% beer as part of a pie chart for your recommended daily calorie intake of 2000 calories

This means you have more information about the milk in your fridge than you do about a bottle of wine, even though the wine has much larger health ramifications and lacks nutritional value. Alcohol is also the second-highest energy-dense foodstuff, second only to fat.

We think that our beermats displaying calories could help. They give a sense of how much you’re drinking across many drinks. People are often shocked to discover that one night of binge drinking can be an entire days’ worth of our recommended calorie intake.

The big picture

I don’t think it’s about scaring people, judging them or telling them what to do. It’s about providing information that isn’t currently available and this should be done as part of a broader approach to reducing alcohol-related harm. Labelling is unlikely to immediately lead to behaviour change. But labelling can, and should, improve public knowledge, which is an essential first step to getting people thinking about alcohol in a different way.

I’m now working on a project called ‘Behaviour Change by Design’, with Bristol and Cambridge universities. We’re taking forward a number of these nudge interventions to help build up a further evidence base. I hope these will help drinkers make more informed choices in the future.

This work was funded by an MRC Public Health Intervention Development grant (reference: MR/N027450/1) and an Alcohol Research UK grant (SG 15/16 222). The Tobacco and Alcohol Research Group are part of the MRC Integrative Epidemiology Unit at the University of Bristol (MC_UU_12013/6).


Hi Anna,

Although, from experience, I wouldn’t trust any research that comes from Bristol’s ‘evidence based’ ‘psychological science’ (all self-contradictory terms) department, it is, nevertheless, good to read that someone else is concerned at the strange anomaly that lets drink manufacturers get away with telling us nothing about what we’re drinking.

I did once take this up with Caledonian Brewers, when I saw that they do put nutritional labels on the beers they bottle for the Coop, but they don’t put these labels on their own brand beers. They could not give me a good reason why they should provide this info to Coop customers, but noone else!

As someone who once kept a nutritional data sheet of everything I ate and drank for 18 months or so (quite likely the most detailed record anyone has made), in order to establish my personal metabolic rate and requirements for no weight gain or loss, I noticed this annoying fact about drinks many years ago–one could, roughly, calculate the calories from alcohol, but many beers were obviously still sweetened and thickened in addition to the alcohol, so one could only guess the calories.

It would be most welcome if you could persuade brewers and other drinks manufacturers to put full nutritional contents (in gm/100gm, and % by weight: NOT stupid vague ‘portions’ or ‘servings’. Accurate kitchen balances are dead cheap: there’s no excuse for such vagaries these days!).

However: I think you are barking up the wrong tree with your trying to teach people by introducing extra, complicating, measures, like ‘Units’, for people to remember, when we already have simple, universal units that everyone agrees on, called ‘grammes’! Adding an extra thing that people have to convert in their heads before they know how much alcohol they are drinking is just plain daft! I would have thought that psychologists would have been the first to appreciate, that adding extra complexity to a simple system makes it far less likely that anyone will bother to learn it! All you need to do, is provide the full nutritional (scientific: not artistic) panel o the back of the bottle, and the calories, and alcohol content in grammes, on the front. Then all people would need to remember is one number: the recommended grammes of alcohol per week, and would not need to work out the vagaries of another set of unnecessary measures between them and the facts.

You may also be interested in another idea I have tried to push, but with, so far, no response from either academics or health professionals: It would be a relatively simple matter nowadays, to use superstores vast databases and stock accounting systems to the health advantage of consumers. Every product bar code is linked to a product description, which, somewhere, will also be linked to the nutritional data table of the product. Thus, if they really wished to help customers improve their healthy eating habits, it would be very doable, to add the total nutritional information of each basket of goods bought by each customer, and to put this info on the till readouts–or even easier for online shopping lists. There would be algorithms in play that would trigger nutritional advice messages customised for each basket of food–and, over time, a complete nutritional picture for each regular customer would build up, which would in turn be of incalculable usefulness to future generations of nutritional scientists. Each customer would be told that, say, ‘the nutritional content of the edible part of your shop, is sufficient for a family of 4 for xx weeks’; and: ‘your basket appears to be low on recommended green vegetables: would you like a complementary cabbage?’. Messages like this would literally be ‘carrot and stick’ ways to get people to gradually improve their diets, and for superstores to become part of the solution, instead of being the main problem. I’m sure that the PR depts of the big chains would be keen to be encouraged to adopt this innovative approach to both nutritional advice, and marketing. I’m sure that any scientist who started thinking about what could be achieved with this data, would soon come up with hundreds more ideas and uses than I’ve thought of. City councils could even use it to draw up detailed nutritional plans for both poor and affluent areas of their towns, and target particular schools, districts, and even individual families with the exact health and nutritional advice they need, perfectly tailored to them via their buying records. Families could even be given the necessary foods to balance their diets, as a way to save money in the NHS in the long term.

You may counter that there are many people and families who do not have regular routine enough shopping habits to be able to benefit from such a system, but I would counter, that there are probably millions enough whose habits are indeed this regular, and who could thus be involved in the biggest nutritional monitoring experiment of all time, with no effort required on their own part, and the opportunities for tailor made special offers and complementary good foods, and dietary ‘reward points’. (There could be prizes for overall reduction in sugar, salt, alcohol etc. over time, for example. Customers could also take the data and add it to their own ‘FitBit’ type apps and other ‘energy in/energy out’ personal accounting systems–something I couldn’t have even dreamed off, when I was writing my own out laboriously on paper accounting sheets!!!).

It is such a shame that all the data that is out there that is routinely collected on us when we buy our groceries, is never collected for scientific use, in an era when it could all be done automatically for almost no additional cost, as it is already part of the supermarkets’ database and inventory.

Hope you have success in getting the labelling of drinks made mandatory, but do, please, consider these much wider advantages, that are just ripe for the picking for anyone with the imagination and backing to get out there and promote these ideas.


Steve Hawkins
Luton LU2 8BA

author avatar by Steve Hawkins on 18-Jan-2019 18:57

I was a fairly heavy and regular drinker until very recently – I am now 67 – an average of 3 pints a day or a bottle of wine – perhaps more – I would estimate 50 units a week. I knew the health risks but, until recently suffered no noticeable side effects including no hangovers. It was not addiction – just pleasure, habit and oral gratification – I could go as long as there was no drink easily available without withdrawal symptom or craving. – and a triumph of hope over facts. It was only the onset of reactions – oral sensitivity and tummy disturbance, coinciding with a desire to shed excess pounds BMI was over 30, and a growing sense of mortality that has resulted in serious reductions in total units and maximum intake. However I feel much better than I expected to. I think genuine testimony to this effect (and calorie information) will have more effect than a lot of health scares which too many people, like me, illogically, think will not happen to them. May well end up a very occasional light drinker.

author avatar by Andrew Metcalf on 20-Jan-2019 17:04

Hurray for the Coop – in reference to the comment above they were the first retailer to include full ingredients on their own alcohol labels and hopefully others will follow

author avatar by Helen on 21-Jan-2019 13:02

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