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Policy Research Programme - Understanding the impact of alcohol calorie labelling on alcohol and calorie consumption

Published

10 May 2022

Version

1.0 - May 2022

Contents

Timetable and Budget

Description

Deadline/Limit

Deadline for Stage 1 Applications

14 June 2022, 1 PM

Notification of outcome of Stage 1 Application

August 2022

Deadline for Stage 2 application

28 September 2022, 1 PM

Notification of outcome of Stage 2 Application

January 2023

Project Start

March 2023

Budget

£700,000 to £750,000

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites a proposal for primary research to support policy makers in the Office for Health Improvement and Disparities (OHID) to shape policy on alcohol calorie labelling. This research call aims to commission one project to consider the following questions:

  • Do intentions to consume alcohol change as a result of alcohol labelling?
  • Do stated preferences for alcohol products change as a result of alcohol labelling?
  • What is the modelled impact of changes to alcohol and calorie consumption on morbidity and mortality?

This is a significant opportunity to contribute to the evidence base on a high profile and important policy area of significant interest to the Government.

Background

Obesity is one of the leading risk factors in ill health and death among working aged adults in England. In 2019, 64% of adults in England were classified as overweight or obese [1] and it is estimated that the NHS currently spends £6.1 billion each year associated with ill-health resulting from individuals having overweight and obesity [2]. These costs are projected to reach £9.7 billion by 2050.

There is a potential caloric contribution of alcohol on weight gain and obesity. Pure alcohol has an energy content of 7kcal per gram which is almost as much as a gram of fat [3]. For those that drink alcohol, its consumption has been estimated to account for 7% of female’s caloric intake and 8% of male’s caloric intake [4]. Each year, around 3.5 million adults consume an additional days’ worth of calories each week, amounting to almost an additional two months of food each year [5]. Consumers are largely unaware of the calorific content of alcohol [6], and many typically underestimate the true calorie content of alcoholic products [7].

Concurrently, alcohol is a cause of over 200 health conditions and although the dose-response relationship between the amount of alcohol consumed and the risk of harm differs across different conditions, with increasing risk of alcohol consumption there is an increased risk of harm [8]. In 2019, over one fifth (22.7%) of English adults are reportedly drinking above Chief Medical Officer’s (CMO) low risk drinking guidelines [9]. For the same year, alcohol was the leading risk factor for ill-health, disability and death for those aged 15 to 49 in England, ahead of both tobacco use and obesity [10]. There is also strong evidence that alcohol consumption causes a number of cancers [11]. A recent study aiming to improve the communication of risk associated with alcohol found that drinking one bottle of wine per week is equivalent in terms of absolute lifetime risk of alcohol-related cancer as the increased absolute cancer risk associated with 5 cigarettes per week for men or 10 cigarettes per week for women [12].

Reducing alcohol consumption is an important area of research for NIHR. Alcohol was a research programme during the first quinquennium of the School for Public Health Research (SPHR); and the PRP both invested in alcohol research through the former Public Health Research Consortium [13] and has recently commissioned an evaluation of alcohol-free and low-alcohol availability.

Due to the high burden of harm caused by both alcohol and obesity, including the relationship between the two risk factors, policies that look to act on both could be greatly beneficial. One such policy area would be alcohol calorie labelling. Alcohol is the only major food or drink product that does not legally require nutritional or calorie labelling.

In recognition of the relationship between obesity and alcohol, particularly the potential contribution of alcohol to excess weight, the UK Government has committed to a consultation to seek views on calorie labelling of alcoholic beverages. Specifically, the introduction of mandatory calorie labelling on alcohol packaging and alcohol served in licensed premises.

We recognise that there are a number factors which influence alcohol consumption and it is clear from food labelling research that providing information is just one contributing factor to possible behavioural change; there are also important environmental and social determinants. However, at present, there is a lack of high-quality research on the possible impact of alcohol calorie labelling on behaviour and the related health outcomes of the population.

Research priorities

Research is required to understand the possible short and possible longer-term impact of alcohol calorie labelling on: alcohol consumption, calorie intake, prevalence of excess weight and obesity, and obesity- and alcohol-related morbidity and mortality; and to consider potential unintended consequences of alcohol calorie labelling.

Understanding the impact of displaying calorie information on alcohol

The research should examine the impact of alcohol calorie labelling on intentions to consume alcohol across different products and different contexts, and whether this varies according to different population groups. We would expect this research to be conducted using experimental methods requiring participants to make hypothetical drinking choices in conditions with and without calorie labels present. Research questions would include:

  • Do intentions to consume alcohol change as a result of alcohol labelling?
  • Does this differ according to how the information is presented on products and/or menus?
  • Does this differ by product type? E.g. wine, beer, spirits, cider

Outcome measures might include intention to consume:

  • Fewer alcoholic drinks/switch to soft drinks
  • Smaller serving sizes
  • Lower calorie alcoholic drinks
  • Lower strength alcoholic drinks

Given the ethical and practical difficulties of examining actual alcohol consumption, it is anticipated that the research will be a hypothetical choice experiment examining intentions. However, we would be particularly interested in proposals which seek to take a novel approach and consider actual purchase and consumption of alcohol.

The experiment should emulate real-life drinking scenarios, as far as possible. Applicants should clearly justify their proposed research design noting that we accept the possible disparity between intentions and behaviour in real world settings, in particular with respect to decisions made under the influence of alcohol.

We would expect the research to explore any difference between on-trade and off-trade alcohol consumption and therefore consider labelling of both products and drinks on menus. On-trade refers to consumption of alcohol in premises such as bars, restaurants, hotels and nightclubs, while off-trade refers to places that sell alcohol for consumption off the premises (for example, supermarkets, off-licences, shops, online-stores).

The expectation is that calorie labels would be developed by the research team, with support from officials in OHID.

Understanding motivations

In addition to experimental work, we would like to gain an understanding of people’s attitudes towards, and understanding of, alcohol calorie labels. Research questions should include, but are not limited to:

  • What are people’s attitudes towards alcohol calorie labelling? Do they think calorie labelling on alcohol would be useful?
  • To what extent do people understand alcohol calorie labels?
  • When and how do people report they might use alcohol calorie labelling when purchasing alcohol in different settings (supermarkets, pubs, restaurants)?
  • How do other factors influence people’s drinking choices? For example, drinking context (e.g. alone, in small groups, in large groups, midweek, weekend, special event), other information about the product (e.g. price, taste preference).

Applicants should set out how they would achieve a representative sample of the UK population. The research should consider subgroup analysis to examine possible differential effects by socio-economic groups, education, age and gender; we are also interested in outcomes according to BMI where possible.

Please outline whether your proposed methodology could look at differences between these groups and how the design would vary for analysis at the level of statistical significance or indicative outcomes only. With this in mind, please could you outline options for sample sizes needed. Applicants should set out what booster samples might be required.

Long term impact of alcohol calorie labelling

Having established these consumer choices and motivations, we would also like to understand the possible long-term effects of alcohol calorie labelling. In particular, we would like to model a range of different scenarios to quantify the potential impact of alcohol calorie labelling on weekly alcohol consumption, and the prevalence of excess weight and obesity. The change in alcohol consumption and excess weight/obesity should then be used to model the long-term impact (e.g. 20 years) on alcohol- and obesity-related harms, including hospital admissions and deaths overall and by specific conditions (e.g. cancers, cardiovascular disease, cirrhosis and other liver conditions, etc.).

Outputs

Outputs should include:

  • interim reports and updates as agreed at project scoping;
  • draft publishable report and final publishable report, with executive and lay summary in a form suitable for policy colleagues in a 1:3:25 format; and
  • a presentation of findings to DHSC colleagues and key stakeholders.

The successful applicant will produce a final report, fully accessible to policymakers and members of the public and circulate to DHSC. When the study is complete, the successful applicants will place a final report summary on the NIHR Policy Research Programme website, where outputs resulting from public expenditure are available for public scrutiny. It is important the final report summaries are easily accessible to lay readers.

Applicants should consider the full range of potential audiences and describe how to disseminate research findings most effectively so lessons from this research affect policy and practice.

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Budget and duration

Funding of £700-750k is available for this research. Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

We expect research projects to be completed within 36-48 months of contracting.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, other stakeholders, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR Policy Research Programme. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

References and key documents

  1. Office for Health Improvement and Disparities (2020) Obesity Profile: Counties and UAs (2020/21). [Accessed April 2022]
  2. Public Health England (2017). Health matters: obesity and the food environment. [Accessed April 2022]
  3. NHS (2020). Calories in alcohol. [Accessed April 2022]
  4. Public Health England (2014). National Diet and Nutrition Survey: Results from Years 1-4 (combined) of the Rolling Programme (2008/2009 -2011/12): Executive Summary. [Accessed April 2022]
  5. mynutriweb.com (2020). Obesity Strategy - more radical action needed. [Accessed April 2022]
  6. Uzogara (2016). Obvious and hidden calories in food and their impact on weight, obesity and wellness: a review. [Accessed April 2022]
  7. Bui, Burton, Howlett and Kozup (2008) What Am I Drinking? The Effects of Serving Facts Information on Alcohol Beverage Containers. [Accessed April 2022]
  8. World Health Organisation (2010). Global strategy to reduce the harmful use of alcohol. [Accessed April 2022]
  9. NHS Digital (2020). Health Survey for England 2019 [NS]: Summary. [Accessed April 2022]
  10. Institute for Health metrics and Evaluation (2019). GBD 2019. [Accessed April 2022]
  11. Bagnardi, Botteri, Tramacere, Islami, Fedirko, Scotti, Jenab, Turati, Pasquali, Pelucchi, Galeone, Bellocco, Negri, Corrao, Boffetta and Vecchia (2015). Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. [Accessed April 2022]
  12. Hydes, Burton, Inskip, Bellis and Sheron (2019). A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine? [Accessed April 2022]
  13. Public Health Research Consortium. Projects related to alcohol 2011-2019 [Accessed April 2022]