Why Do Alcoholics Lose Weight?

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Alcohol Abuse Is Associated With Social Difficulties, Stress, And Weight Loss

Living with unemployment, homelessness, discrimination, and violence may cause malnutrition and weight loss due to stress, lack of appetite, lack of money for food, or lack of access to food.

These and other such challenging social circumstances such may also lead to hazardous drinking habits and excessive alcohol consumption as a means of coping with everyday life [1].

While heavy drinking is always a risk factor for alcohol addiction, studies suggest that people who are poor, marginalised, undernourished, and traumatised, may be at particular risk of developing alcoholism, now called alcohol use disorder, or AUD [2, 3].

Therefore, it cannot be assumed that weight loss is a direct result of alcohol abuse.

It may be that the weight loss and excessive drinking share a common cause, and that this common cause may be found in the social circumstances in which the person lives.

Mental Illness, Alcohol Abuse, And Weight Loss

Mental illness [4] and neurodivergence [5] (autism, ADHD, dyspraxia etc) may also lead to concurrent weight loss and alcohol abuse.

People with eating disorders such as anorexia and bulimia may replace food with alcohol in an attempt to restrict calories [6].

Their low weight and emotional distress will render them particularly vulnerable to developing AUD [1].

People with psychosis (schizophrenia, bipolar, some forms of personality disorder and depression) often struggle to obtain and to prepare food for themselves and often use alcohol to cope with distressing experiences, unmanageable emotions, and the side-effects of medication [7].

Neurodivergent people may struggle with body image or the sensory aspects of eating, and may find that drinking alcohol helps them to manage their social anxieties [5].

Mental health struggles, as well as social difficulties, may also be associated with concurrent low body weight and AUD.

Again, weight loss should not necessarily be regarded as a direct result of alcohol abuse but as part of an array of psychosocial challenges.

Sensitive and well-informed medical attention in combination with intensive social support and high-quality mental health treatment can be very effective in helping many people with milder alcohol use disorders to improve their eating habits and regain weight.

However, treating weight loss and encouraging weight gain in people with more advanced alcohol use disorder, with co-morbid diabetes and AUD, and with co-morbid eating disorders and AUD is usually more problematic [6].


Alcoholic Use Disorder (AUD) Impacts Self-Care

In AUD, compulsions and cravings for alcoholic drinks overtake even the most basic aspects of daily living [8, 9], including eating.

People with alcohol use disorder lose weight because their calorie intake has dropped below their energy requirements for everyday life.

This may be because:

  • They are too preoccupied with drinking to be concerned with food
  • Their lives are too chaotic to enable them to shop, and cook, regularly or safely
  • They are spending all their money on alcohol, and therefore cannot afford to buy food
  • They do not have the facilities to store or to prepare food, and do not consider obtaining these important

Alcohol research shows that weight loss in AUD often forms part of a wider pattern of self-neglect [11]. 

Self-neglect [12] is often a particular problem for the follow groups of people who abuse alcohol:

  • Older adults
  • People with learning disabilities
  • People who struggle to engage with statutory services
  • People who lead very isolated lives

Severe Alcohol Use Disorder Impairs Digestion

How Does Alcohol Affect Nutrition?

Alcohol is extremely harmful to nutrition because it inhibits the absorption of a range of vitamins and minerals, particularly vitamin C, vitamin B12 and thiamine [13].

Vitamin and mineral deficiency may lead to loss of appetite, which causes weight loss.

How Does Alcohol Affect Vital Organs?

Alcohol causes widespread organ dysfunction to all body systems, but particularly to the liver, cardiovascular system, heart, and brain.

Organ dysfunction can lead to weight loss.

Alcohol And Liver Disease

The liver is the main organ of alcohol metabolism, i.e. converting alcohol into less harmful substances for the body to process.

When the liver receives too much alcohol, either through binge drinking or sustained heavy drinking, it becomes unable to process essentially fatty acids.

These fatty acids remain in the liver, causing fatty liver, which is the earliest stage of alcoholic liver damage [14].

If these fatty acids continue to accumulate through continued drinking, fatty liver may develop into alcoholic hepatitis or liver cirrhosis, known as alcoholic liver disease, and can cause liver failure [15].


Alcoholic Hepatitis

Alcoholic hepatitis usually develops when drinking heavily and persistently over time.

The main symptoms are usually fever, jaundice (yellow-coloured skin), and steatorrhoea (pale, foul-smelling diarrhoea, which contains large amounts of fat) [16].

Steatorrhoea occurs because the liver has become unable to process fatty acids, meaning that any fat eaten is lost in faeces rather than used or stored as energy.

In alcoholic hepatitis, is this steatorrhoea which causes weight loss [15, 16].

Alcoholic hepatitis may be managed through medical treatment.

In more severe cases, however, it may lead to fibrosis and to liver cirrhosis [15, 16].

Liver Cirrhosis

Liver cirrhosis develops either after long term alcohol abuse, or many years after a person with AUD has managed to stop drinking [15].

People with liver cirrhosis may experience symptoms similar to those of alcoholic hepatitis, but tend also to present with heavily swollen abdomens due to ascites, or excess fluid which accumulates around the liver and spleen [17].

This fluid causes weight loss because it reduces stomach capacity, leading to loss of appetite and feelings of bloating which deter eating.

However, this fluid can itself be of significant weight, with the result that treatments for cirrhosis which involve draining the ascites may also cause sudden weight loss.

Therefore, cirrhosis may cause but also mask weight loss in people with AUD.

In its earliest stages, cirrhosis may be reversible through treatment.

However, people do not experience symptoms of cirrhosis until it becomes irreversible.

By this point, the only treatment is a liver transplant [15, 17].

Drinking May Cause Indirect Weight Loss Via The Cardiovascular System

Alcohol raises blood pressure, which can cause hypertension (high blood pressure) and heart problems [18].

If not controlled by healthier lifestyle or medication, hypertension may lead to atrial fibrillation, strokes, heart attacks, and cardiac arrest [19].

Over the longer term, chronic hypertension weakens the heart itself, causing cardiomyopathy and other forms of heart failure [20].

Heart failure causes a form of weight loss called cachexia [21], in which a lack of oxygen throughout the body causes muscles to shrink.

Unless hypertension can be managed, heart disease caused by AUD is extremely difficult to treat [18].

Brain Issues Associated With Alcohol Use Disorder Make Self-Care Impossible

Alcohol abuse, AUD, and the circumstances surrounding these, may be associated with conflict, violence, and abuse [1].

People with AUD are at increased risk of accidents, falls, and becoming victims of crime, and therefore have an increased prevalence of brain injury [10].

AUD can also cause brain damage due to stroke, and to the general frailty which alcohol use causes.

Wernicke's encephalopathy and Korsakoff's psychosis are forms of brain damage caused by the lack of thiamine absorbed by people with AUD [22].

WKS causes confusion, disorientation, movement problems, and difficulties in forming new memories.

WKS and many other forms of alcohol-related brain damage cause weight loss because they impair personal independence and the ability to feed and care for oneself [10, 22].

People with end-stage AUD may therefore need intensive personal care support to maintain their weight, general wellbeing and personal safety [11, 12] .

Does This Mean Drinking Alcohol Can Be Used To Lose Weight?

Only by making oneself extremely ill.

People with diabetes who drink alcohol to lose weight are at high risk of negative consequences and potential death from ketoacidosis.

For most who drink, alcohol will not help with losing weight and will not achieve any weight loss goals. 


Alcohol And Weight Gain

Drinking alcohol at lower levels will usually cause weight gain.

Alcohol is an energy-dense sugar, and alcohol calories are empty calories, or energy with no nutrients or sensations of satiety.

Alcholic drinks disrupt blood sugar levels, resulting in increased feelings of hunger.

Moderate drinking reduces inhibitions, meaning that alcoholic beverages can lead to consuming extra calories.

However, the UK National Institute for Health and Care Excellence (NICE)'s guidelines on alcohol and weight, advise against heavy alcohol use as a strategy to maintain a healthy weight [23].

Seeking Help For Alcohol And Weight Issues Combined

Recommendations for becoming a healthy weight and living a healthier lifestyle include a eating a balanced diet, practicing optimal portion control, and regular physical activity.

However, given that alcohol abuse is so frequently associated with complex social difficulties, mental health challenges and thiamine deficiencies, people with AUD should seek more specialised help to manage their weight.

Ideally this would allow cessation of drinking entirely.

Receiving professional help is especially important for people with AUD who also have diabetes and/or eating disorders.

Further Support

Support groups such as AA [24] and SMART Recovery [25] are open to all, and work hard to welcome new members.

NHS alcohol and drug partnership services [26] provide addiction and mental health treatment, care, and support to people with alcohol problems.

These can be accessed through referral from GPs and social care, signposting from pharmacies, and outreach from other services.

NHS services are free to all UK residents, as well as to refugees and asylum seekers and to some overseas workers.

Many voluntary sector organisations also provide a range of alcohol services.

The NHS website provides a directory of services [27] available across the UK.

Abbeycare [28] is one of the UK's leading private providers of alcohol treatment.

In addition to its own services, Abbeycare's website provides a comprehensive free guide to finding and accessing the right form of treatment [29].

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About the author

Laura Morris

Laura Morris is an experienced clinical practitioner and CQC Registered Manager with over twenty years experience, over ten of which have been as an Independent Nurse Prescriber.

She has held a number of senior leadership roles in the substance use and mental health sector in the NHS, the prison service and in leading social enterprises in the field.

Last Updated: November 30, 2023