Thursday, February 03, 2011

Why I still think breakfast's part of weight management.


Much ado has been made of a recent study that suggested that eating large breakfasts added to total daily calorie counts with pretty much all coverage suggesting that folks trying to lose weight should think twice about having it, or more specifically, how much of it.

The study, published in advance of print in Nutrition Journal, monitored the dietary intake of 280 obese and 100 normal weight subjects for 10-14 days. Researchers were interested in total daily energy intake as a function of total daily breakfast calories.

Right off the bat this was a strange study as it would seem that virtually all of the subjects were eating 3 meals and 2 snacks daily - a pattern of eating that is not one I see regularly. Of the literally thousands of patients whose eating patterns I've explored, I'd venture a guess that 3 meals and between meals snacks were a regular and consistent pattern in no more than 10% of them. Of course this study was conducted in Germany and my practice population is Canadian, so perhaps this concern is unfounded in that perhaps Germans are great snackers and don't skip meals.

Ultimately the study concluded that in both normal weight and obese individuals who are weight stable, higher breakfast calories resulted in higher total daily calories.

The problem I have is that there are far more variables than simply breakfast that determine total daily satiety and satiety has a great deal of bearing on total daily intake as hunger will impact dietary quantity and choice. Other things that matter a great deal? Macronutrient distribution, timing of meals and snacks, sports nutrition and minimums of calories per meals and snack.

Folks reporting on this study have basically been telling people that if they want to lose weight, they should just eat less for breakfast. Of course telling someone to simply take what they're currently eating and eat less (for breakfast) falls into that nonsensical, oversimplified, nightmare on ELMM (eat less, move more) street scenario whose value and worth we all know too well. Moreover, according to news reports on the study, the primary driver of higher calories for breakfast was bread, which if refined, ain't going to help satiety much either and therefore perhaps it's not surprising that high breakfast calories led to great total weights as loading up on bread for breakfast will certainly impact total calories, but might not impact satiety and consequently not impact on rest of day eating patterns.

So is breakfast importance in weight management? Well 78% of the National Weight Control Registry eat breakfast daily. For those who aren't familiar, registrants have lost on average 67lbs and kept them off for over 5.5 years. They're great at managing their weight and while that number very clearly states that 22% of registrants don't eat breakfast daily, that the vast majority does speaks directly to breakfast's importance to most folks' long term strategies.

So while an interesting result and one perhaps worthy of further study in a population that's actually trying to lose weight, the fact that normal weight or obese individuals who have had stable weights for at least a year, eat more total daily calories on days they have larger breakfasts, doesn't change the fact that my recommendation for folks trying to lose weight is for breakfasts of at least 300 calories (though certainly >500 calories is probably overkill), consumed within 30-60 minutes of waking and containing a good source of protein, followed by well organized meals and snacks throughout the remainder of the day.

Schusdziarra, V., Hausmann, M., Wittke, C., Mittermeier, J., Kellner, M., Naumann, A., Wagenpfeil, S., & Erdmann, J. (2011). Impact of breakfast on daily energy intake - an analysis of absolute versus relative breakfast calories Nutrition Journal, 10 (1) DOI: 10.1186/1475-2891-10-5

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