A1 Refereed original research article in a scientific journal
Alcohol consumption, smoking, and weight loss outcomes: findings from a 12-month digital lifestyle intervention; 
Authors: Wu, Emma R.; Joki, Anu; Venäläinen, Mikko S.; Suojanen, Laura-Unnukka; Pietiläinen, Kirsi H.; Ahola, Aila J.
Publisher: Oxford University Press (OUP)
Publication year: 2026
Journal: European Journal of Public Health
Article number: ckag072
Volume: 36
Issue: 3
ISSN: 1101-1262
eISSN: 1464-360X
DOI: https://doi.org/10.1093/eurpub/ckag072
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.1093/eurpub/ckag072
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/526574684
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
To investigate associations between alcohol consumption, smoking, and weight loss outcomes over a 12-month digital lifestyle intervention, the Healthy Weight Coaching. Weight, height, and waist circumference were self-reported at baseline, followed by weekly weight and quarterly waist circumference reporting. Interpolated weights were used to calculate body mass index at 3, 6, 9, and 12 months. At these timepoints, relative changes from baseline in weight and waist circumference were calculated. On web-based questionnaires, participants reported alcohol consumption (frequency, single-session dose) and smoking (status, daily dose, start age, end year). Participants were categorized as abstinent, low-risk drinkers, and risky drinkers (men: >14 units/week or >6 units/occasion; women: >7 units/week or >5 units/occasion), and as current, former and non-smokers. At baseline, of the 1719 participants (83.3% women, median age 51 years, body mass index 39.1 kg/m2), 20.9% reported abstinence and 16.2% risky drinking, while 12.1% and 22.3% were current and former smokers, respectively. Alcohol consumption decreased over the program, driven by reductions among baseline risky drinkers. Among baseline non-drinkers, increased alcohol intake over 12 months was linked to smaller waist circumference reduction (weekly dose, B = 0.762, P = 0.005; single-session dose, B = 1.168, P = 0.020). Instead, among baseline risky drinkers, cutting alcohol intake was linked to greater weight loss (weekly dose, B = 0.062, P = 0.034; single-session dose, B = 0.321, P < 0.001), and larger waist circumference reduction (single-session dose, B = 0.381, P = 0.031). Higher number of pack-years was associated with attenuated waist circumference reduction (B = 0.059, P = 0.002). Addressing alcohol consumption and smoking may improve weight loss outcomes in digital lifestyle interventions. The trial is registered at clinicaltrials.gov (Clinical Trials Identifier NCT04019249).
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Funding information in the publication:
This study was supported by Academy of Finland, grant numbers 266286, 272376, 314383, 335443, and 369181; Finnish Medical Foundation; Gyllenberg Foundation; Novo Nordisk Foundation, grant numbers NNF10OC1013354, NNF17OC0027232, NNF20OC0060547, NNF24OC0091683, NNF25SA0103783; Finnish Diabetes Research Foundation; Finnish Foundation for Cardiovascular Research; Paulo Foundation; Sigrid Jusélius Foundation; University of Helsinki and Helsinki University Hospital; Government Research Funds. Funding sources were not involved in the interpretation of data, writing of the manuscript, and the decision to submit the article.