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When forgoing food for booze takes you over the limit

May 16, 2013 | 12:00 a.m. CST

Photos by Roxana Pop; Illustrations by Kristina Houser, Megan Madden, Connie McCollom, Elizabeth Pierson and Roxana Pop

Have you ever heard of drunkorexia?” I ask the men in line at Harpo’s on a Saturday night. An indiscernable, bass-heavy rap song thump-thump-thumps from the packed bar, and they don’t hear me the first time. “Drunkorexia,” I yell, “It’s when you starve yourself intentionally so you can save the calories for booze.”

By the numbers

39% The percentage of students who reported restricting calories before alcohol consumption in a 2010 study

20% The percentage of college students who believe they’ve suffered from an eating disorder at some point in their lives

16 The number of calories in a one-ounce shot of Smirnoff blueberry vodka

110 The number of calories in a 12-ounce Bud Light

177 The number of calories in a single 8.45-ounce Smirnoff vodka and tonic

76%The percentage more likely that individuals who vomit or use laxatives are to binge drink

80K The number of alcohol-related deaths in America each year; alcohol is the third leading lifestyle-related cause of death.

1.2 mil The number of emergency room visits due to excessive alcohol consumption in 2006

Statistics from: Journal of American College Health; 2006 survey by National Eating Disorders Association; MyFitnessPal. com; Centers for Disease Control and Prevention (CDC)

Each one gives me a puzzled look and then shouts a response.

“It’s called alcoholism.”

“It’s called college.”

“If you’re hungry, have a beer. Makes sense to me.”

The men quickly escape into the mass of college students looking to get drunk and women in tight dresses squeezing their way through the crowd to reach the bar. The one in front of me orders seven mixed drinks as her friends hand her cash. “Wait, so three rum and Cokes and four vodka tonics?”

I wonder which patrons skipped dinner.

“Every once in a while, I’ll hear of someone who didn’t eat,” says Tim Schearn, an MU senior. “It’s obviously a thing. They don’t say ‘drunkorexia,’ but girls will say they’re really drunk because they didn’t eat. They brush it off as if it’s something to do. It’s just a normal thing, like a student norm.”

Schearn says sometimes he and his friends will forget to eat during the day and then just get food after the bar. “For me, me and my friends think, ‘Oh, I guess this is a good thing because then we’ll get drunk faster,’” he says. “But it’s not like we’re deliberately doing it.”

Drunkorexia is a media-invented street term not recognized by the medical community. Culturally speaking, a drunkorexic looks at food and sees a hidden cost; those 400 calories could be spent on beers or liquor instead. It’s a matter of exchange. Never mind the binge eating that occurs post-bar at the nearest hot dog stand, late-night diner or El Rancho on Broadway. Eating after heavy drinking defeats the initial purpose of foregoing food for the night. Although most individuals who participate in this behavior are women, guys are no exception.

A 2010 study in the Journal of American College Health explored the drinking and eating habits of students at 10 different universities. Of more than 4,000 participants, 39 percent of students who drank within the past 30 days reported restricting calories on days they planned on drinking. A majority did so because of weight concerns. Women who participated in drunkorexic behavior were more likely to experience negative alcohol-related consequences, such as memory loss and unwanted sexual advances. Men, on the other hand, were more likely to get into fights.

The media coined the term drunkorexia in 2008, and last December, MTV began a search for a drunkorexic to document in a True Life episode. But drunkorexia’s buzzword status represents a trend that’s been prominent for much longer than the term’s short existence. Rachel Winograd, a Ph.D. student studying psychology, conducted research about drunkorexia at MU starting in 2009 and says this behavior pattern is probably not all that new.

“I’d imagine that as long as weight-conscious people have wanted to get drunk, this behavior has been displayed,” she says.

MU senior Ali Burgoon estimates about 10 percent of the classmates she knew during her freshman year participated in some kind of drunkorexic behavior, but she hasn’t seen it happen since she began hanging out with her core group of friends.

“From my experience, it seems like the behavior is a lot more prominent in underclassmen,” she says. “A lot of it is hush hush; it was an unspoken thing that was going on.” The people whom she saw taking it to an extreme level already had issues with an eating disorder, anorexia or bulimia, she says.

Burgoon speaks of a friend she knew in high school who was bulimic and often drank on an empty stomach after working out. “Sometimes she would eat an entire bag of Gardetto’s when she was drunk, and then she would go throw it up,” she says. Her friend was always sick. “We confronted her about it, and she would not have it. She pushed us away.”

People participate in drunkorexic behavior for a variety of reasons, Burgoon says — some psychological and some related to the modern college lifestyle. “Sometimes it might just be, ‘I don’t want to spend as much on drinks; I’ll just eat less for dinner,’” she says. “It’s very much a gray-area topic.”

Aubrey Koehler, another MU senior, had never heard of the term drunkorexia, but she has seen a couple of her friends restrict calories intentionally before going out and then “totally regret it because they get wasted,” she says. It’s usually a one- or two-time incident before they decide not to do it again. However, she notices they intentionally order drinks with fewer calories. “They’ll definitely choose liquor over beer, like a vodka water or liquor and diet (soda). I see that all the time with my girlfriends, or they’ll look up online the drinks with the least amount of calories.”

Although she never counts calories herself, Koehler notices her friends choose a salad over a cheeseburger and fries on nights that they plan on drinking. Still, she says, this does not seem like the extent of a disorder. “It’s maybe more a conscious thing, like ‘I’ve been proud of myself for working out and eating healthy, and then I’m going to go out and drink, and then I feel like shit because I’ve just ruined my diet on beer and liquor just to have a good time,’” Koehler says. “So they’re trying to compensate for that.”

The women who seem most concerned about alcohol calories, she says, are those who exercise frequently and watch their weight day-to-day. “All the girls I’ve seen do it are really fit, in-shape people,” she says. “They’re very attractive.”

Drunkorexia encompasses a variety of behaviors, from “I’ll have salad tonight because later I’m having a high-calorie drink” to “I’m starving myself to get plastered later,” but people generally associate the term with the most extreme cases, according to Winograd. Whether it’s a temporary choice or a true disorder, drunkorexia sounds pathological, she says.

“The ‘–exia’ makes people think eating disorder,” Winograd, the psychology Ph.D. student, says. “But if you think about a behavior like restricting food prior to alcohol consumption, which is what I call it now, it totally exists on a spectrum. For all we know, healthy, weight-conscious adults might skip the bread at dinner and instead order a fruity cocktail. Would we call that person eating-disordered? I highly doubt it.”

For some, intentionally not eating before a night of heavy drinking has nothing to do with saving calories. Andrew Fox, an MU senior, would rather skip the meal if he’s planning to get inebriated, and it’s all about convenience and money. Typically, Fox says he consumes 10 to 15 alcoholic drinks on an average night out. If he were wealthier, he would probably eat and still have cash for drinks. He explains he’s really “just being a bum.”

At the Campus Bar & Grill patio on a Tuesday afternoon, Fox orders the popcorn chicken with his beer, but only because it’s happy hour, and that means half-price appetizers. When it comes to calories, Fox says he “could probably use some,” but he hates spending money. When the waitress gives him the bill of $9.33, he shakes his head and mutters, “See the expense of it.”

As an underclassman, Fox often refrigerated his dinner from the cafeteria to eat when he was drunk and ravenous after a night of heavy drinking, and now he often overeats at El Rancho in the early morning because he’s so hungry. “If I’m going to be drinking, you know, if I have an empty stomach, that’s better because I can get drunk off fewer beers and get drunk faster,” he says. “So it’s good in terms of intoxication and frugality.”

Fox’s friend, Jim Beverley, also a senior, says that eating just slows down the drinking. “I can’t eat and drink at the same time, really,” he says. “Adults tend to drink while they eat dinner and stuff; I don’t do it. I like to keep them separate.” Beverley sees his behavior as a lifestyle he’ll probably rethink after college. “Grown-ups think, ‘If I don’t go out to eat, I can spend this money on my kids’ education or my bills,’” he says. “For me, it’s like, ‘How many beers can I buy at dollar bottles tonight?’”

Beverley and Fox admit the nights that they drink on an empty stomach result in more blackouts and worse hangovers. “My stomach is just gurgling booze in the morning,” Fox says. They’d rather remember what happened the night before, but it’s not enough to deter them from the next weekend binge.

After all, waking up and not knowing how you got there isn’t exactly a warm and fuzzy feeling to have; Fox and Beverley both agree on that.

“I think the regret is there,” Fox says. “But we don’t act on that.”

What is a self-proclaimed lifestyle choice for Fox and Beverley could be a disorder for others. Winograd explains that a connection exists between bulimia and other externalizing disorders, which occur when people go out and participate in abusive behaviors such as fighting and substance abuse. These externalizing disorders share a common thread of impulsivity, she says. A 2006 study by The National Center on Addiction and Substance Abuse found that 50 percent of individuals with eating disorders abuse alcohol or drugs, compared to 9 percent of the general population. Those who suffered from bulimia were especially likely to cross over into alcohol abuse.

Cindy Foley, registered dietician and MU Wellness Resource Center wellness coordinator, individually meets with students who struggle with eating disorders at MU and says she sees the connection between bulimia and substance abuse more so than anorexia. The students Foley sees who exhibit signs of drunkorexia are mostly women who express concern for wanting to lose weight. However, since she heard the term drunkorexia in 2010 and began recognizing the behaviors, Foley has seen an increase in the number of men whom she counsels for eating disorders. “(Men) can hide the binge eating more,” Foley says. “Oh, it’s just a guy eating a whole bunch of food.”

Foley counsels students to understand not only the risks of heavy alcohol consumption but also how extreme dieting forces the body into a fat-sparing mode, which means the body doesn’t know when it will be fed again and starts saving fat. The body’s rate of metabolism slows down, which increases the number of fat calories that will be stored. “You could almost make a pros and cons list,” Foley says. “Sometimes the students’ objective is to get as drunk as they can, and we have to deal with that reality. But we can help them understand that starving themselves will actually have the opposite effect that they desire, especially because it almost guarantees binge eating later in the night.”

MU Wellness Resource Center Director Kim Dude says she became aware of the drunkorexia phenomenon two or three years ago, and it’s an issue she addresses in her lectures around campus. “When I’m doing presentations and I talk about it, I can see the look on peoples’ faces; ‘Oops, I’ve done that,’” she says. She points out that with eating disorders in general, it’s difficult to gauge the prevalence of the disorder on campus because that would require a student admitting his or her drunkorexic behavior.

Dude says she’s not sure if anyone has come into the Wellness Resource Center owning up to drunkorexic behavior, but that doesn’t mean she’s not concerned. “It’s a dangerous thing to do, for anybody to drink on an empty stomach and especially someone who has restricted their calories all day,” she says. “Somebody might do it once or twice, or somebody might do it on a regular basis.”

It’s no mystery that drinking on an empty stomach causes the alcohol to absorb more quickly into the blood and makes you feel drunk faster, but it’s worse for women than for men. Foley says there is evidence that women will achieve a higher blood alcohol concentration than men even after drinking an equal amount. Women are especially prone to the negative consequences of pouring liquor into an empty stomach due to the smaller quantities of alcohol dehydrogenase, the enzyme that metabolizes alcohol, in women’s bodies and less body water to dilute the alcohol. These consequences might be more severe than a night with your head in the toilet bowl or a pounding head the next day. According to the 2010 study on drunkorexia, women who restricted calories before drinking were more likely to be injured, taken advantage of sexually or to have unprotected sex.

Jacquelyn Francisco, MU Brief Alcohol Screening and Intervention for College Students coordinator, counsels students who have been written up for alcohol dorm violations to reduce risky alcohol-related behavior. During the group counseling sessions, they discuss what the students dislike about how alcohol makes them act and feel. Every time, a woman will bring up the topic of the calories in alcohol and how she fears the weight gain, Francisco says. When she meets with students one-on-one, some of them discuss intentionally restricting food calories throughout the day to make up for their drinking.

“The ironic thing is, most of these girls will choose liquor over beer because they see beer having a lot more calories,” Francisco says. “That’s not the case.” She explains the discrepancies between what students believe about their alcohol consumption and the reality of their actions, such as possible unwanted binge eating if they choose to starve themselves.

The Wellness Resource Center, Women’s Health Center, MU Counseling Center and BASICS program are all resources available to students who wish to get help. But as Dude points out, the reality is that students are influenced most by peers.

“The difficult part about alcohol is that you can be saved 364 days a year, but on that 365th day, if you do something that is dangerous, it can have horrible, life-changing consequences,” she says. “The question is trying to get people to not only take care of ourselves but take care of each other.”

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