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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  1. I personally think that the biggest thing to come out of all of this new meal frequency research in the past couple of years is that you don't HAVE to eat breakfast (or even multiple meals and snacks) every day to lose or maintain weight or experience improvements in health.

    All too often I think we're trying to force square pegs into round holes by forcing busy people to eat several times per day when this is far from necessary.

    If the peg fits (i.e., you have a fequent snacker) then great. But if not, I don't think there is a huge difference if the total calorie deficit is reached for the day.

    And the weight control registry (while excellent information) is not really a RCT so we can't make cause and effect conclusions.

  2. Can you explain why you aren't a supporter of the eat less, move more theory?

  3. Sure I can.

  4. Yoni,

    You are one of the few experts who state the Eat Less, Exercise More equation is wrong-minded. And for that, I applaud you.

    That equation is a myth and I believe causes most people to not even attempt weight-loss and living a healthier lifestyle.

    It implies deprivation and willpower. Both are sure to backfire.

    My slogan: Eat More, Weigh Less, and be Healthier

    That's the great news. You can eat more and the foods you eat taste incredible. It certainly is not about eating more celery.

    Thanks for the info.

    Ken Leebow

  5. Christina RD9:28 am

    Most of the research I have read has shown that breakfast eaters tend to weigh at least 5 lbs less than the skippers, not to mention the positive benefits on energy level, concentration, and mood in the morning. The most common breakfast for the weight loss registrants was a high fibre cereal.

  6. I’m part of the 22% of the National Weight Control Registry who *doesn’t* eat breakfast daily. I’ve lost 75 pounds and kept it off for 5 years, without regular breakfast.

    If I’m hungry when I wake up, I eat breakfast – if I’m not, I don’t, and mostly, I’m not hungry. But I don’t stress about it either way.

    I do find that if I eat breakfast, I’m hungry at about 10am and hungrier at lunch and dinner. If I don’t eat breakfast, I have to remind myself to eat lunch around 1pm or so.

    I suspect that eating breakfast works well for most people but not so well for others – and what everyone needs to do is figure out which group they fit best in. I object to the dogma of ‘breakfast is the best way to start the day’, as if that should apply to every single person when, clearly, it doesn’t. It’s clear from all the various studies and results that different dietary approaches work for different people. I believe it’s the responsibility of the health industry to make that clear and *help* people determine which approach works best for them, whatever the dogma may be.

  7. Joanne10:53 am

    I guess the main question I have is that if a normal weight, breakfast-eating person is maintaining her weight despite eating more calories a day, what's the problem?

  8. Joanne10:56 am

    To clarify - you stated that the study was conducted on weight-stable people.

    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.

  9. Anonymous11:20 am

    The picture and masthead suggest that you are promoting French fries as part of healthy eating.

    The fat used can contain up to 24% trans-fat. The result leads to AGEs, the thing plugged arteries. Not good. More misleading inconsistent advise.

    I personally do not eat sugar, grains, lubricants or manufactured eatable product. This is the Paleo treatment for obesity and hyperinsulinemia. It worked for me.

    but what do I know.

  10. Monisha11:42 am

    I think the 'what' of breakfast has to matter alot here. I lived in Germany for a few years as a post-doc and am married to a German of working/middle class (i.e., not highly educated) background, so I have a broader exposure to 'typical' breakfast patterns in that country. My in-laws eat what amounts to refined bread with copious amounts of butter and jam for breakfast, virtually every day. They are overweight (not obese) and weight-stable. I'd also not be stunned to find that Germans are more consistent about consuming at least three meals and one snack per day (that was the eating pattern at the institute where i worked - where everyone ate lunch together and also had a coffee and cake break around 4pm).

    I also suspect, as with one of the earlier commenters, that there are alot of not-yet-understood individual differences in all of this - my husband is a routine breakfast skipper with an extremely healthy and stable weight. If I even try skipping breakfast, I doom myself to a major migraine by 2pm. It may also be related to differences in circadian patterning - he's an eat alot at night, go late to bed, and ideally, get up fairly late person. I'm asleep by 11 up at 6 person, and although i tend to eat alot in the evenings for social reasons (b/c hubby is doing it!), my weight is better managed when i do NOT do that.

  11. Alexie7:27 am

    I want to know more about how this study was done. Were the participants asked to eat a big breakfast? Was this unusual for them? Or did they recruit people who specifically eat big breakfasts? If so, maybe they were eating the rest of the day as they normally do.

    I too live in Germany and they do not believe in a big breakfast. Bread and jam, OR a small bowl of muesli, OR bread with slices of meat and cheese are common. The big meal of the day is lunch time though that's slowing being replaced with a big dinner meal.

    The other thing is that the Germans still adhere to old-fashioned rules about eating: home cooked, no snacking in public, strong social mores around how snacks are eaten (e.g. the Sunday coffee and cake ritual).

    If participants were asked to eat a greater breakfast than normal, they may not have had a choice about how many calories they ate during the rest of the day. I would not be able to go home to my partner and tell him thanks but no thanks to the dinner he'd prepared, because I'd participated in an eating experiment.

  12. I agree with Mark Young here. I am rarely hungry in the morning so why eat? Back when I did calorie reducing diets, eating breakfast meant I had consumed ~1/4 of my daily allotment and that only seemed to make me more hungry when time came to eat my measly lunch. I would have been far better off eating two large/satisfying meals rather than the 3+2.

    One wonders how much of the childhood obesity epidemic is due to pushing this whole notion of making breakfast a must.

  13. Carbsane and Mark,

    There's no doubt that there are folks who don't require breakfast to manage calories.

    There's also no doubt that many do.

    The point of breakfast calories (and protein) isn't to work on morning issues, but rather evening and night ones.

    For many, and having worked with literally thousands of patients I can tell you it's the vast majority, missing morning calories impacts on control in the evening - portion wise and choice wise in that if they miss breakfast calories or protein, their struggle with control is heightened in the evening.

    Of course if you've found ways to manage calories that don't include breakfast, I certainly wouldn't encourage you starting to have breakfast.

  14. Anonymous12:39 pm

    It would be interesting to know if they looked at why the participants were unwilling to eat breakfast. Logic says that if you are hungry for breakfast, you are likely to eat it. I know from experience of spending time in Spain that when you eat a substantial meal late at night (9-10 pm) I am generally not as hungry for breakfast the next morning. During my normal routine at home, I eat in the early evening (6-7 pm) and then awake at 6:30 AM. By the time I arrive at my office at eat breakfast (8:30-9 AM) I am starving. But wouldn't most people be feeling very hungry when not eating for 14 hours?

    Whenever people tell me they aren't hungry in the morning I assume its because they eat later in the evening or snack late at night. Eat a light dinner at 4:30 and don't eat after 5 and I guarantee you will be wanting breakfast between a few hours of waking.

    Now, it's probably not a bad thing to skip breakfast if you ate a reasonable meal late at night and don't feel hungry in the morning. However, if you ate a reasonable meal at 6 and then snacked from 8-11 I can see the problem. Its easy to mindlessly consume calories in the evening hours when you are at home relaxing.

  15. Anonymous8:25 pm

    More about Breakfast Skipping

    Breakfast: to skip or not to skip?

    Front. Public Health, 03 June 2014 | doi: 10.3389/fpubh.2014.00059


    Given body of evidence reviewed in this opinion article, it is reasonable to suppose that skipping BF could be as metabolically beneficial as excluding late eating, as well as stress the importance of the overnight fast. Perhaps it does not matter which of the daily meals – the first or the last – is omitted as long as at least once in a while, an inter-meal interval is long enough to allow the state of ketosis to initiate lipolysis and lower calorie intake, thus decreasing the risk of obesity and its comorbidities.

    Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence

    Background: Various intentional and unintentional factors influence beliefs beyond what scientific evidence justifies. Two such factors are research lacking probative value (RLPV) and biased research reporting (BRR).

    Objective: We investigated the prevalence of RLPV and BRR in research about the proposition that skipping breakfast causes weight gain, which is called the proposed effect of breakfast on obesity (PEBO) in this article.

    Design: Studies related to the PEBO were synthesized by using a cumulative meta-analysis. Abstracts from these studies were also rated for the improper use of causal language and biased interpretations. In separate analyses, articles that cited an observational study about the PEBO were rated for the inappropriate use of causal language, and articles that cited a randomized controlled trial (RCT) about the PEBO were rated for misleadingly citing the RCT.

    Results: The current body of scientific knowledge indicates that the PEBO is only presumed true. The observational literature on the PEBO has gratuitously established the association, but not the causal relation, between skipping breakfast and obesity (final cumulative meta-analysis P value <10−42), which is evidence of RLPV. Four examples of BRR are evident in the PEBO literature as follows: 1) biased interpretation of one's own results, 2) improper use of causal language in describing one's own results, 3) misleadingly citing others’ results, and 4) improper use of causal language in citing others’ work.

    Conclusions: The belief in the PEBO exceeds the strength of scientific evidence. The scientific record is distorted by RLPV and BRR. RLPV is a suboptimal use of collective scientific resources.

    Received April 15, 2013.
    Accepted August 20, 2013.