Tuesday, March 29, 2011

Is "Fourth Meal" contributing to rising obesity rates?

Never heard of "Fourth Meal"?

According to Taco Bell it's, "the meal between dinner and breakfast", and kidding aside, it makes me think.

Certainly for College students out partying, Fourth Meal's pretty normal. I certainly had my share of Fourth Meals back in the day.

But what about the rest of us?

I'm betting that Fourth Meal is far more common than most might think. Now it may not be a formalized meal, but I know that night eating is certainly a prevalent affair. And it may actually only be "Second Meal" as that person may well have skipped breakfast and lunch.

I'm guessing there are a great many packs of cookies and whole bags of chips that make up home based Fourth Meals.

My take on night eating is that more often than not it's a response to poorly organized daytime eating and that once a person's eating every 2-3 hours, with sufficient calories and protein, nighttime struggles (and Fourth Meals) tend to disappear.

Don't believe me? It certainly can't hurt to try.

Here's what I'd recommend:

  • Breakfast within 60 minutes of waking up.
  • Eating every 2-3 hours.
  • Meals with a minimum of 300 calories for women and 400 calories for men.
  • Snacks with a minimum of 100 calories for women and 150 calories for men.
  • 8 or more grams of protein with every meal and snack.

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    1. If we needed to eat every 2-3 hours, our species would have gone extinct years ago.

      Eat enough high-quality protien and fat, and it's easy to go 6-8 hours without a meal.

    2. Hi Steve,

      Can and should and two very different things, and while there are certainly individuals who handle physiologic hunger well, there are many who don't.

      Also, I would have to respectfully disagree about the utility of considering what our species would or wouldn't have done in the past as the environment we live in now, and our longevity, are very, very, different than they once were.

      All that said, if you've found a way to help your patients with their weight management efforts through eating every 6-8 hours, clearly you should stick with your set of rules/advice.


    3. Anonymous9:29 am

      Is your advice for maintaing weight or for losing weight?

    4. Both.

      In the sense that my advice recommends minimums (not maximums) of calories.

      By being more organized with meals, snacks, calories and protein my hope would be that folks who tend to struggle with evening hunger or cravings, will struggle far less and leave themselves more able to control portions and choices.

    5. Yoni, I agree with you. Although most nighttime eating is a stress or reward response, if you feel the urge, you are likely to consume a low nutrient snack after dark.

      Worse still is that insulin response is slower in darkness, so night time calories are the most likely to store as fat. Fourth meal knows all this.....

    6. Studies have failed to show that eating high eating frequencies reduce hunger or lead to spontaneous reductions in calories consumed.

    7. Anonymous10:49 am

      I completely agree with you Yoni. Eating every ~3 hours and including protein in meals and snacks (particularly earlier in the day) are the exact recommendations I give to my clients.
      Neal - which studies are you referring to?

    8. There are lots of studies out there.

      There are studies that demonstrate snacking helps to manage calories and there are other studies that demonstrate it doesn't.

      My experience is that it does, at least in the context of the program we provide.

      Steve's likely is that it doesn't, at least in the context of the program he provides.

      Ultimately though, it's an easy science experiment for someone who is in fact struggling with night time dietary restraint and control. If my recommendations help, wonderful. If not, no harm done.

    9. Anonymous12:25 pm

      Personally, I think people staying up longer watching TV, and have developed the habit of eating during TV watching (the commercials/product placement doesn't help). If you eat at 6, and watch TV until 10, you will start to feel hungry again. Since there's alot of evidence that people aren't getting enough sleep, I think unless they're out there at night running marathons (no), they are replacing that sleep with sedentary activity and excess calorie consumption.

    10. simba1:18 pm

      I thought the fourth meal was supper? Hot chocolate on cold nights, fruit, cereal or leftovers and a glass of water on normal ones. I've started them in college, but it's the done thing in some families I've stayed with.

      Nothing too big, nothing hard to digest, just a pre-bed ritual for those who eat a light dinner.

    11. Nurse Ingrid8:22 pm

      I am approaching my one year anniversary of maintaining a 50 pound weight loss, Yoni, and I pretty much follow the meal/snack routine you describe, aiming for a total calorie intake of 1700-1800 per day.

      My problem is that some days I get up before 7AM and don't go to bed until after midnight. On those days I either have long gaps during which I do get hungry, or I end up exceeding my caloric budget for the day. I also tend to exercise late in the day, which means I usually exercise hungry so I can eat afterwards.

      I am experimenting with making the meals and snacks smaller and spreading them out more, which helps. Any other ideas?

    12. I favor the pattern as described in the Lord of the Rings..

      Breakfast, second breakfast, elevenses, luncheon, afternoon tea, dinner and (later in the evening) supper.

      Though practically, I have breakfast, tens, lunch, threes, and dinner most of the time, without recourse to anything between dinner and breakfast.

      I often find that the later I eat dinner, the earlier and larger I want my breakfast to be the next morning. So most of the time I keep these two meals about 12 or 12.5 hours apart and it works well. I don't wake up starving and am satisfied with a bowl of cereal/oatmeal.


    13. Hi Nurse Ingrid,

      I'd point out that different days will require different strategies and your longer days may well require more calories.

      I'd rather you ate 200-300 more calories on your longer days but didn't battle hunger or cravings than have you fight those demons regularly.

      Goal's the smallest number of calories you need each day to be happy. Don't treat calories as ceiling. Some days need more.

      Longer days I'd probably add two additional snacks. One in the longer afternoon and one immediately before or after your workout.

      Yes, it'll be more total daily calories, but you're burning more too as you're awake and active longer. Ultimately though better you happily eat a few more calories than fight hunger regularly or feel guilt when you go over an artificial limit.


    14. Nurse Ingrid9:32 pm

      Many thanks, Yoni. That is extremely helpful. In practice, what you have suggested is pretty much what I end up doing on my long days. But your advice will help me not beat myself up about it.

      Your point about needing/burning more energy on a longer day is a really good one. Getting too hungry is a sure way for me to overeat, and your strategy should help prevent that. OK, I need to go have a snack now before dance practice. Love your blog!

    15. Good article - The more we eat the more you weight we gain. If the amount of calories going in is more than the amount of the calories we burn then we gain weight.

      Surely this is just a case of self education - We can't have these fast-food companies marketing a "fourth meal" - it's disgusting.

    16. Anonymous11:33 am

      Isn't your recommendation a version of ELMM ST?

      As a woman I would eat 300 + 100 + 300 + 100 + 300 + 100 = 1200 cals a day

      That would be "eat less" for most women , I think. I'd loose weight on 1200 cals / day.

      I think you said it's good to move to stay healthy, but not to try to burn off 1000s of calories by activity.

      So move enough to stay healthy and eat by your plan ... you're on ELMM ST, losing weight.

      Actually, that sounds pretty good to me.

    17. Umm, how would me recommending you eat a MINIMUM number of calories per meal and snack be ELMM Street exactly?

    18. Your recommendation is pretty much what happens in practice most days in my life experiment, n=1. Days that I have lunch meetings, I adjust my timing, snack content, etc. When I have to contend with a potluck, I adjust. Holidays, I adjust. But, what you describe is pretty much what happens most of the time: ice skating on a single blade at the edge of hunger, never dropping a foot, lest I mess up my endocrine and cue the persistent "eat now" impulses (my words, since I've not seen these impulses described elsewhere) or, worse, actual, physical hunger.

    19. Anonymous1:17 pm

      Eat every 2-3 hours until when? Until bedtime or until supper time (3rd meal of the day)? What exactly do you recommend regarding night eating?

    20. The only meal/snack that's skippable in my books is the last one of the day.

      If your day's longer, as noted, you'll need to have a larger number of calories and snacks and if really long, perhaps even another meal worth of calories.

    21. Anonymous11:36 pm

      ELMM ST plan: "Eat Less, Move More"

      Eat Less = eat less calories than your body needs to meet energy requirements.
      (I'm assuming "less" refers to calories, not volume or weight of food. eg 2 cups lettuce is "less" than 1 cup ice cream).

      Your minimum plan. (1200 cals over 6 meal/snacks a day), is a calorie level at which I myself would gradually lose weight.

      ... that would be a good thing for me!!

      For someone else, losing weight could be bad - so I guess they'd up the calorie intake, keeping the same overall pattern, to maintenence level, which of course is not " ELMM ST"

      For me, your minimum cal pattern happens to fit with EL of "ELMM ST"

      The fact that I need to lose weight, by ELMM or otherwise, is an indication that I've been EMML-ing for way too long.

    22. Yoni, thank you for bringing up the topic of meal frequency. My personal view is different.

      After we establish our basic calorie requirements, there are only three things we can change.
      1. the makeup of the meal
      2. the amount of calories in the meal
      3. the space between the meals
      Add to this that life is difficult if we are hungry, and the total daily calories cap, we can do the math any number of ways.

      First is to test the total number of calories, but what I found was when I included a little bit of grain, I was hungry, therefore no grains. Also with grains, my weight was stable at 1500 C/Day. When I went to about 50 ± 25 grams of carbs per day, I lost on 1800 C/day. This can be explained by Atwater’s missing data and the Co2 / O2 ratio, and water production is thermogenic, but does not produce bio-available energy. A Calorie is a unit of heat, not bio-available energy.

      To get along on about 1600 C/day, the only way was ≈450 for breakfast, ≈450 for lunch, and ≈700 late, about 2 before bed. Life had to be busy between meals. It is more about a enjoyable life between meals without temptations for me than the meals.

      I tracked the breakfast and lunch meals for the time until hunger, and found that if there were starches in either, I would get hungry faster, more calories per hour, to adjust for variation. Calories/time to hunger should be talked about more. I tried 4 meals/day for a while, but smaller meals left me unsatisfied after the meals. Snacks made the problem worse. I realized that protein and a busy life are both necessary for termination of a meal with satisfaction. Fat was necessary to postpone later hunger. Tea with coconut oil in the afternoon made a big difference to late day hunger with only a few calories. ( pure fat snack)

      I tried 2 meals per day, but found the only way to control the hunger was not to eat until about noon. One meal a day (truck stop noon meal)was better than two, after a while, the hunger does not bother as much after I got used to it.

      I found it easier to loose weight than maintain, hence have gone to a cycle of about 4 kgs, gain, and then cut carbs and loose. I use potatoes, rice, peas, corn, parsnips, and navy beans as starch. They do not make me as hungry, unlike grains.

      My credentials are not in nutrition, I just read and test it on myself.

    23. Ah, Fourth Meal... Thanks to Taco Bell for coining the term so we can have common language to talk about this phenomenon. I was just speaking with someone yesterday who literally became weak at the knee and put out a hand to steady themselves when I suggested that she not eat anything after dinner to help manage her weight. She told me that it would be impossible because she was always starving at night. Dr. Freedhoff's assumptions as to why in this post are spot on!

      The comments on this post echo something I'm a big fan of - that we're each individual and have unique nutritional needs. There are some things that are common for all people (like we all need plenty of fresh veggies and dark leafy greens daily) and there are others that we have to figure out what is best for us as an individual (like whether you eat 3 meals, 3 meals and snacks, or whatever).

      Personally, I eat 3 meals a day and can't imagine eating anything else. And, my meals are not large or high calorie - a green smoothie for breakfast, a salad and either a bowl of soup or a small sandwich for lunch, and then some veggies and whole grains for dinner.

    24. Anonymous10:17 am

      On a primal diet of about 1600 cals a day (49, f, 152 lbs) I've steadily been losing weight since March (25lbs to date).

      This is eating 3 meals a day - no need to snack excluding the occasional mid-afternoon apple.

      You DON'T need to eat every 2 hours. Skip the 100 calorie snacks and give your body time to digest the food you ate at your actual meal time and burn off some stored fat. If you eat approx. 500 cals per meal (fat, protein, minimal carbs) you won't be hungry in between.

      Try it, you might like it. I do!