Risky Drinking Among Adults With Obesity Common

An estimated 1 in 10 U.S. adults had overlapping heavy drinking and obesity conditions in 2023, a cross-sectional study found.

In a survey of roughly 45,000 U.S. adults representing more than 257 million people, 9% said they had obesity and drank heavily over the past month, while 3.8% said they had both obesity and met criteria for alcohol use disorder (AUD) over the past year, reported researchers led by Bryant Shuey, MD, MPH, of the University of Pittsburgh.

Overlapping heavy drinking and obesity was most common among men ages 35 to 49 (13.6%), women ages 26 to 34 (11.9%), and Black individuals (11.9%). AUD and obesity overlap was highest for men and women ages 26 to 34 (6.2% and 5.1%), people without insurance, and those on Medicaid, the findings in JAMA Internal Medicine showed.

Shuey and colleagues said the findings on this high-risk population call for public health and clinical interventions tailored to younger and middle-age adults, especially the uninsured and those on Medicaid, to prevent liver disease and liver-associated deaths.

Insurance coverage of evidence-based therapies for the two preventable risk factors, which “contribute synergistically” to rising rates of liver disease and death, is also needed, according to the researchers.

“While evidence is limited on concurrent treatment of risky alcohol use and obesity, clinicians should offer interventions that are effective for both conditions, including motivational interviewing, cognitive behavior therapy, and pharmacotherapy,” wrote Shuey and colleagues.

Given the effectiveness of GLP-1 drugs “for weight loss and metabolic dysfunction–associated steatohepatitis, expanding access for patients with co-occurring risky alcohol use and obesity may reduce liver disease burden,” they argued.

Real-world data have also shown lower AUD-related hospitalization rates for people on GLP-1 drugs, and the researchers pointed to early trial data showing these drugs can help people with AUD reduce their drinking.

“If this finding is confirmed in larger studies, GLP-1 receptor agonists could become a dual therapeutic for risky alcohol use and obesity,” the authors suggested.

In their introduction, Shuey and co-authors noted that heavy drinking in people with obesity has become more common in recent decades, but that the prevalence has not been evaluated since the COVID-19 pandemic, a time when multiple reports indicated increases in alcohol abuse and associated complications. Furthermore, the prevalence of obesity and AUD together has not been looked at.

Their study utilized 2023 National Survey on Drug Use and Health data from 45,133 respondents, representing a total weighted population of 257.5 million adults. About half of the survey respondents were women (51.3%), and 61.2% were white, 17.6% were Hispanic, 12.1% were Black, 6.2% were Asian, 2% were multiracial, and 0.4% were Native Hawaiian or Pacific Islander.

Obesity was defined as a body mass index (BMI) of 30 or higher. Past-month heavy drinking was evaluated by the National Institute on Alcohol Abuse and Alcoholism definition (for men: ≥15 drinks per week or ≥5 drinks per day; for women: ≥8 drinks per week or ≥4 drinks per day). Past-year AUD was defined using DSM-5 criteria.

Nearly 100 million adults were estimated to have obesity, around 60 million to drink heavily, and about 30 million to have AUD.

Men and women with obesity ages 65 and older had the lowest rates of heavy drinking (6% and 3%, respectively) and AUD (2.8% and 0.8%).

Stratified by race and ethnicity, Native Hawaiian and Pacific Islanders had the highest overlap with AUD (7.3%). Conversely, Asian adults reported the lowest prevalence for both obesity and heavy drinking (2.1%) and obesity and AUD (1%).

Uninsured adults had a higher prevalence of overlapping obesity and heavy drinking (9.7%) and AUD (4.5%) than insured adults. Adults covered by Medicaid or the Children’s Health Insurance Program (CHIP) had the same 4.5% rate of overlapping AUD and obesity. Higher income correlated with higher prevalence of overlapping heavy drinking and obesity but not overlapping AUD and obesity.

The study findings might have been limited by self-reporting bias, and underreporting of AUD may have overestimated rates of heavy drinking, the researchers acknowledged.